An Unplanned Cesarean Birth

Joanne Fouts with her newborn babyWe had followed with a midwife throughout our pregnancy, but made the decision to have a home birth about 4 months before our first son was born. I was a medical student and was called to participate in yet another delivery. I walked into the room and the site I saw got me thinking. The woman was laying there in bed with her legs spread apart in stirrups, her bottom was painted orange from iodine and there was a spot light shining on her bottom as well. She was wearing an oxygen mask and hooked up to IVs. There were also about 5 or so medical staff in the room as well. I realized at this point that a hospital delivery was not for me.

I started labor around 7pm on a Monday, the day after my due date. The contractions were regular, about 3-5 minutes apart but were not too strong. I was so excited about soon being able to meet our little one, that I really did not sleep much if at all. About 3 am the contractions were painful enough to keep me from sleeping at all, so I got up and took a warm bath. After my bath, my husband woke up and asked me what was going on. When I told him I was in labor, he was excited and also decided that he should make a run to the grocery store to stock up on food and drinks as we planned on staying at home for some time after the birth of our child. By morning, the contractions were increasing, but still tolerable. We called our midwife and she saw me around 9am. I was only dilated to 2cm at that time. We went home and I continue to labor throughout the rest of the day. As the day grew on, the contractions were becoming much more painful. Around dark, we called our midwife again to have her come over as I was having difficulty handling the contractions and had been in labor for about 24 hours. When she came, I was only about 4 cm dilated. We also discovered that the baby was OP, Occiput Posterior. I labored hard throughout the night, with essentially no sleep. I was on my knees for so long trying to flip the baby that my knees became sore, yet the baby never turned to the right position. By morning, after about 36 hours of labor, I was still only 6 cm dilated and had been at 6 cm for at least 7 hours. It was at this point, after two nights of no sleep and such intense contractions and lack of progression that we made the decision to head into the hospital.

At the hospital, I did receive and epidural and an IV. They also started pitocin to augment my labor. During labor, there were some concerning changes with the baby’s heart beat, so they started an amnioinfusion and I also received a catheter. I eventually made it to complete around 5 pm. The epidural had worn off quite a bit and I felt I was able to push fairly well. After 2 hours of pushing, we did seem to be making progress, but when they checked baby’s head position he was only at zero station (still fairly high up) and all the progression we had thought we were seeing was only caput (swelling). The concerning pattern of baby’s heart beat had also returned and was worsening. After much pain and emotional agony, I did submit to a cesarean section. During the section, our son’s head was so wedged in my pelvis from the pushing, that they needed an attendant to push from below while the doctor pulled from inside my uterus. They told my husband to go grab his camera and I lay there waiting for them to show me my son over the blue surgical drape. I was waiting and waiting and then realized that he was already over of the baby warmer. I could only see his leg and it was very blue. They called for a code pink, which is the same as a code blue but for newborns. I felt a surge of emotion run from me towards him. It was at that time that he let out his first cry. His first APGAR was only 2, but his 5 minute APGAR was 8. They let me touch him briefly before taking him to the critical care nursery as he was having some struggle breathing. They ran a bunch of tests on him and placed him on oxygen. It was 4 hours after he was born before I got to hold him for the first time. I was unable to get out of bed from the recent cesarean, but the wonderful nurses working with me that night wheeled my entire bed into the critical care nursery. I remember him laying there with the oxygen hood on and crying so much that his body was pink. They took him out of the oxygen hood and handed him to me with some blow by oxygen. Within just a couple minutes he stopped crying, calmed, and fell asleep in my arms. It was such a wonderful experience to hold him for the first time. All the tests they ran came back normal, but he still needed oxygen and it took them a couple of days to wean him off of the oxygen. It was 2 days before I was able to breast feed him, though they had been feeding him my pumped milk through a nasogastric tube. I was worried that with the two days since he was born and only feeding through the tube that he would have difficulty latching on and breastfeeding. My worries were soon gone as he took right to breastfeeding without any difficulty.

Processing my birth was fairly difficult, as it was not at all what we had thought would happen. A friend of mine and I were discussing our births shortly after I returned home and she talked of the euphoria that swept over her after her vaginal delivery, which is not something I was able to experience with a cesarean birth. It was quite difficult for me as I felt I had failed in some way by not being able to deliver naturally. I remember telling myself that though this time it did not go as planned, next time I would try for a VBAC and it would go better. When I met with my OB 2 weeks after delivery for my incision check, she told me very honestly that she did not recommend a VBAC next time before I even mention that I was thinking of having a VBAC. She informed me that my pelvis is very narrow and the shape of it predisposes me to OP babies. That paired with the fact that my babies are big (my first was 8 pounds 1 ½ ounces) and also have larger than average head size meant a natural birth was not in my future. This was hard to process for me as well. To want do deliver as naturally as possible and being told that this was not possible was hard to accept. When I became pregnant with our second child, I was still going to try a VBAC until I realized late in my second trimester that he was even bigger than my first. I had chosen a different OB this time who was very supportive of VBACs and natural deliveries, but after my repeat cesarean he told me that it was a good decision that I did not try a VBAC. Me second son was indeed larger with an even larger head. I now have 3 sons who are all healthy and beautiful. Though it is still hard for me to accept that I cannot have a natural birth, I am beyond happy that I can conceive and have such wonderful and lovely children.

Story submitted by Joanna Fouts