My story illustrates the impact that birth trauma can have upon women. On Tuesday, 16th September 1986, two weeks past his due date, my son Jeffrey was delivered via caesarean section, weighing 9 lbs. 13 oz. I had begun pre-natal care at 22 weeks with a doctor who was recommended by a friend. The doctor indicated that he supported my birth plan for a natural birth with a minimum of interventions. My doctor had privileges at two hospitals. During the third trimester, my partner and I toured both. I selected the hospital whose standard procedures were less invasive; no IVs or enemas and they encouraged walking through labour.
A little after midnight on September 16th, my water broke. I had no contractions at this point, but called my doctor. He said that he had a patient in pre-term labour at 26 weeks, who required his attention and that I would need to come to the other hospital instead. After a quick shower we drove there, where my partner dealt with the paperwork while I underwent their standard procedures including an enema and insertion of an IV needle.
By this time, I was having strong, regular contractions. I was then taken to a labour room and placed on foetal monitoring and was unable to walk about. Despite these interventions, I managed the pain and laboured naturally for nine hours. My doctor checked on my progress several times, but was focused primarily upon his other patient. I progressed well and by 7.00, I was 9cm.
At 9.15 when my doctor checked again, I was still 9 cm and the baby had not descended. He said that he could allow me to labour longer but it would make no difference; the baby was too big. After nine hours of intense contractions, a partner that spent more time in the cafeteria or asleep and lying flat on my back staring at the walls, it was then that I lost it and began to cry. Within 15 minutes I was in the theatre and they were administering a spinal. At this point I was so exhausted that once I no longer had the pain of the contractions, I fell asleep.
I remember very little until that afternoon. My vague memories include Jeffrey’s first cry and my ex bringing me a picture of him in the recovery room. Because he had swallowed myconium, he had to be observed in the nursery and I did not get to hold him or attempt nursing until that evening. I was not able to have rooming in because of the caesarean and despite the sign in his bassinet that instructed the nurses he was to be breastfed on demand, he was given formula and not brought to me for hours at a time.
At that time, I was greatly disappointed that I had a caesarean and felt as if I had failed somehow as a woman. I was also intensely angry at my doctor. I felt that despite a good relationship during my pregnancy he had let me down when I needed him most. I was especially angry about the tone he had used with me when suggesting that a caesarean was necessary. I felt that the tone of voice he used when telling me that he could allow me to labour longer but it would do no good was bullying. I remember later comparing that experience to emotional rape.
Because my son was in the nursery most of the time and my partner was at work, I was left alone in my hospital room for most of the day. I cried often during my five day hospital stay. I was angry too that the nurses had more time with my new baby than I did. I got to see him for only part of the day. I never got to keep him with me at night. Our breastfeeding experience got off to a rough start because he was given bottles of formula against my wishes. It was as if the nurses felt they knew better for my baby than I did. I undermined my confidence as a new mother.
Even after we left the hospital, we continued to have difficulties. I had a mild infection on my incision. My son had a bacterial infection that caused blisters. It began on his scalp where they had inserted the monitor, but soon covered the area under his fat little arms. He also developed a severe case of thrush that made breastfeeding a complete nightmare. It was over two months before my sore and cracked nipples healed. I can clearly remember sitting down on the couch with my son to breastfeed and crying in pain.
Eventually I moved on emotionally or so I thought. I realised the truth when over eighteen months later I found out that I was pregnant once again. All of my old fears and feelings re-surfaced. I sat and cried for hours; not because pregnancy was unplanned or the additional strain that another child would place upon our finances or troubled relationship, but because I would have to endure another caesarean. I began to look for alternatives and eventually found a midwife that would consider a homebirth. Our first pre-natal visit lasted almost three hours and was more about debriefing from the trauma of my first birth than my physical condition.
But even the successful VBAC homebirth of my 7 lb. 14 oz. daughter did not lessen my anger at what I thought was an unnecessary intervention. In fact, a casual comment by my midwife that my pelvis was more than adequate caused my anger to intensify. In a classic Post Traumatic Shock Disorder experience, that comment re-ignited all the feelings that I had experienced right after the surgery. I tried to channel my anger in a constructive manner. I became a crusader for natural birth; taking a lay midwifery course. I tried to find an attorney to sue my doctor, but the statute of limitations had expired.
For five years after my caesarean, I often wondered about the what-if’s. What if I had stuck with my plan to deliver at the other hospital with its less intrusive procedures? What if I had walked about or laboured standing up? What if I was not continuously monitored? Every time I got caught up in those what if’s, I would become angrier or depressed. Few people have the true benefit of hindsight, but I was blessed with a chance to once and for all settle those what if’s.
Those questions were answered once and for all with my second homebirth. This son was considerably larger than my daughter weighing 8 lbs. 15 oz, but still smaller than his older brother. I had a very short and intense labour of less than two hours. I had what many would consider an ideal natural birth. I laboured upright and walked about through out early labour. I pushed in a position comfortable to me. I had a wonderful support person in my midwife and her assistant. I was comfortable in my home, but my son became stuck in the birth canal. My experienced midwife said that his shoulder dystocia was one of the worst that she had dealt with in her decades of practice. She felt that prayer was the only thing that saved my son. After birth, his breathing was depressed and his one minute APGAR was barely 4. All of the what-if’s that had haunted me for five years were gone. It is sad to say but it was that experience that allowed me to release the anger at my doctor that I had been carrying for almost five years.
It was this experience that made me realise for the first time that cephlo-pelvic disproportion was not some made up condition used by doctors to pressure their patients into unnecessary caesarean sections. I suppose that the permanent ridge on the top of Jeffrey’s head where he was wedged against my pelvic arch should have indicated this sooner, but it is often easier to blame others than to accept our own liability. I began to accept that my caesarean had been the result of overeating in pregnancy, which resulted in a baby too large for my pelvis.
My emotional healing was completed over a decade later with the birth of my youngest son. I had planned a midwife assisted hospital birth. I was confident that I would have no difficulty with another VBAC. I stayed home during early labour and went to the hospital only once labour was well established the contractions close together and so intense that I was having difficulty managing them. I was sure based upon my earlier labours that the baby’s birth was imminent, but when checked I was only 2 cm dilated.
The baby was posterior and my intense back labour was not effectively dilating my cervix. I tried labour upright in the shower. I tried walking. I tried lying on my side. Nothing worked. The pain was more intense than any of my previous labours. I knew that if I choose to have an epidural I would significantly increase my chances of having another c-section, but the pain was so intense that I made the decision to have it anyway. Several hours and several interventions later, I did indeed have another caesarean. This time though rather than anger and resentment, I owned my decision. I was confident that I had done the best I could for me and my baby.
The other part that was healing for me was that in the fifteen years since my first c-section so much had changed that many of the things I had most hated about the experience just did not apply. When my son was born, they brought him to me to touch before placing him in the warming bed. My partner, his mother and Jeffrey were able to touch and talk to the baby while the surgeons sewed me up. Then I was taken to the recovery and reunited with my son; less than an hour after his birth. The nurses helped me to nurse him immediately. Best of all, the hospital encouraged rooming in for all babies. My partner stayed with us even during the night and the only time my baby was separated from us was for about 15 minutes each day for weighing.
It was as if I had come full circle. Despite the fact that the procedures were the same, I was a different person. I had matured. I had learned my rights and responsibilities. When I was faced with an unfamiliar situation, I knew the benefits and risks of all my choices and I easily accepted the consequences of those choices. I was empowered by the same procedure that had once left me so emotionally scared that I suffered from Post Traumatic Stress Disorder. Some of it was because I had changed and some of it was the result of changes within the medical system.
As a mother who has experienced three caesarean births, I at times become very frustrated with the natural birth movement. Yes, the natural birth of my daughter and despite its difficulties even my second son were wonderful. They in some ways healed my inner woman after the first traumatic caesarean, but neither of them were perfect either. I wrote and carefully discussed elaborate birth plans with my midwives and neither birth followed the plans.
Births almost never follow plans. I spent five years angry and depressed for absolutely no reason. How many other women have experienced this pain which inflicts a scar much deeper than a caesarean birth? I have often wondered what would have happened if that shoulder dystocia had not occurred. Would I have continued to be angry at my doctor and depressed? Would my PTSD ever completely healed? Of course, I will never know the answers to those questions. And I feel deeply for the tens of thousands of women who never have the clear answers that fate provided me.
But my experience has led me to begin childbirth education classes and doula services specifically for these special women and babies for whom caesarean birth is chosen. I believe that with compassionate support and care the breastfeeding rates among these families can be dramatically increased and more importantly we can help them to heal quicker both physically and emotionally. This is my unique vision and mission; my long journey back from birth trauma.