photo by Sarah Shields
In honor of C-section Awareness month, I wanted to share my birth story.
I wish I could tell you that I had the most blissful pregnancy after going through years of infertility and finally IVF to conceive. The reality (in short) is that I had bleeding throughout my first trimester. My progesterone was low, so I was doing progesterone shots in my glutes and an extra progesterone suppository in my vagina throughout the first trimester. I had headaches, acid reflux, nausea and vomiting, insomnia, tailbone pain and swollen feet, but otherwise I couldn't really complain. Although I was pretty sick and miserable for most of my pregnancy, I was absolutely overjoyed to have a little girl on the way. Looking back, I can see the blessing in disguise - I didn't have the capacity to worry about what could go wrong. Sometimes when you know too much or have a research brain like I do, you can end up in some pretty deep rabbit holes. Instead of wasting energy worrying, I focused on "nesting" - creating a beautiful nursery and researching the best "toxin-free" baby products I could find.
Having a uterine anomaly (I have a unicornuate uterus/half of a regular size uterus) automatically put me in the high-risk category. So, I was monitored quite closely throughout my pregnancy. It’s also common to have breech babies with this type of uterus, as there is not a lot of extra room to flip. Knowing the odds were against me, I still tried. I did all sorts of things to try to get her to flip, but she was snug as a bug. It became very apparent that she was happy right where she was. At 37 weeks and 2 days, my sweet baby was still breech and was measuring less than 1 percentile on the growth chart (they called this severe IUGR/intrauterine growth restriction). Luckily, she was healthy and had a strong heartbeat. After the maternal fetal medicine specialist (MFM) saw my high blood pressure that day, they sent me up to my OB, who told me I had preeclampsia and sent me to labor and delivery. After being monitored and waiting 5 long hours, the OB came into my room, sat on the edge of my bed and told me there was a rumor going around that I like even numbers. Why yes, YES I do. He said something like, "Wonderful! Tomorrow is 8/20. How about you guys go home, pack your bags and come back in the morning to have this baby?"
We thankfully got a chance to go home, sit on the couch, and hold hands for our last night together before bringing our baby girl into the world (insert sarcasm). Actually, I finished packing and tried to clean a little (with a kitchen reno that was still not even close to completion - I told you I was nesting hard core!). My husband picked the top 2 things on his priority list - he mowed the lawn and fixed our broken toilet. A good story isn’t good unless it includes ALL the details, right?!
One of the things I always tell my patients is to prepare yourself for all variations of birth and not to get too attached to one specific plan. From the very beginning, I knew a C-section might happen, given my unicornuate uterus. I also dreamt of a natural, unmedicated birth. But, in the end, my option was a C-section, and I had a pretty good idea of what I wanted that to look like. I shared my ideas with my OB, and she was on board.
My C-section delivery “preference" was to have the most natural, gentle Cesarean possible. I got a lot of my ideas from "The Mama Natural" book by Genevieve Howland. A sweet patient gifted me this book, and I highly recommend it! This is what my "plan" looked like with comments how each idea worked out:
IV, blood pressure cuff, and ECG electrodes placed in areas that don’t obstruct my ability to see, hold, or breastfeed baby
I do not want my arms strapped down during the operation.
No problem. In fact, I was told this is "common practice" at my hospital.
Non-drowsy anti-nausea med if possible (i.e. Zofran)
100% on board. Just talk to your anesthesiologist about this beforehand.
Clear drape – raised just before delivery so I can watch as my baby is born
Again, no issues here. They did tell me that even with a clear drape, it can be hard to see, and they weren't keen on raising the drape. So, they asked me if I would like a big mirror to be able to see better. ABSOLUTELY I did!! They told me most moms don't want that option, but I personally loved seeing everything!
Measure and draw an even line before cutting. I want my scar to look as good as possible.
They did measure and draw a line before cutting. I wanted the doctors to know this was important to me, so that they would take their time and do their best. But, at the end of the day, I am well aware that this is a major abdominal surgery. As a pelvic physical therapist, I know that an untreated scar can lead to urinary issues, constipation, pain with intercourse, abdominal, pelvic, hip and/or back pain, and secondary infertility if not addressed postpartum. I'm currently going to pelvic physical therapy myself, and I've seen a lot of improvement already!
I would like to know the “play-by-play” during the surgery.
We had a conversation throughout the entire process. At one point, they were humming and hawing, and I asked what was going on. They told me that because of the way my uterus was shaped, it looked like they were going to have to do a vertical incision of my uterus. Further explaining that if I were to get pregnant again, and the baby was head down, a vaginal delivery would not be an option. I was okay with that in the moment. I am sad that I won't likely have the option for a vaginal birth in the future, but I know they made the best decision given the situation.
Doctor will free baby’s head but allow baby’s body to linger inside the uterus. The goal is to compress the baby’s torso which helps to drain any fluid from her lungs/mimicking a tight squeeze through the vaginal canal.
This wasn't really an option since she was breech, but my doctor tried to be as slow and gentle as she could be.
Leave cord intact for a few minutes until it’s done pulsating ensuring that the baby is still receiving oxygenated blood from placenta and Ryan (my husband) to cut the cord.
They didn't delay clamping very long, and Ryan didn't get to cut the cord. It was maybe 30 seconds before they clamped and cut. However, they did milk the umbilical cord, which was great. Perhaps my idea of delayed cord clamping was much more delayed than theirs. I should have been more specific with what that meant to me. Looking back, we probably could have reminded them, but we were all too caught up in the moment.
Vaginal seeding to restore baby’s microbiome with a vaginal swab or gauze pad to dab in/around baby’s mouth, nose, eyes, ears, face
I did put some gauze in my vagina when I got to the hospital. But honestly, I didn't really think it through. The nurse gave me a big wad of gauze, and really you just need a little. I wish I would have put it in at home the night before and taken it out right before the surgery. It wasn't perfect, but we tried. haha :)
Baby is placed directly on my chest/torso for immediate skin-to-skin bonding with warm blanket on top of me. If I’m physically unable, Ryan and baby skin-to-skin. Newborn procedures (unless medical emergency) are delayed for skin-to-skin bonding – baby’s health assessed while she lies on my chest vs. warmer.
I did get warm blankets, and I did get skin-on-skin but not right away. They took her over to the warmer and did health assessments for about 5 minutes before I got to have her on my chest. But, I did get to do skin-on-skin right after that (in the OR). I would have preferred her on my chest immediately. But again, they have their protocols, and I think it's hard for them to adjust when they have a typical routine. In the future, I think I would advocate to be allowed to bring a doula in the OR with me to be my voice/give gentle nudges/reminders.
Initiate breastfeeding immediately and continue to breastfed while incision is sutured.
I got to continue holding her skin-on-skin as they closed me up, but we decided right before the surgery that breastfeeding would be too difficult. As a first-time mom and awkward positioning, I decided they were probably right. I was okay with waiting and initiating breastfeeding immediately once we got back to the recovery room.
Please take extra time to close incision for best scar outcome.
I think they did their best.
Delay first bath – leave vernix on
They did wipe off a little more vernix than I would have liked. The vernix is so good for babies, so I would have preferred to have rubbed it all in versus wiped any of it off. However, we delayed her first bath 8 days. We did her first bath at home with just a little warm water and washcloth.
My catheter and IV out as soon as possible after surgery
Unfortunately, this was not an option. Because I had preeclampsia postpartum and my blood pressure wasn't coming down, they put me on "Mag" (magnesium sulfate). I'm not going to sugar coat it...this stuff was terrible. I was nauseous, dizzy, and had a terrible headache (which are all common side effects). As a result, I didn't get my catheter out for 2 days.
Another recommendation that I’m glad we opted for was to delay any visitors until we had plenty of time to soak in those first few hours of our baby’s life. Both of our families were waiting to meet her in the waiting room, but those first few hours were so important to soak in just the 3 of us. It was such a special time.
All in all, I LOVED my birth and was so grateful to have a say in how I wanted it to go. My husband and I held hands as Gianna Everly Marshall was born, and we both cried (so many happy tears) as we watched her come into the world. Overall, I felt very supported by my OB and most of the hospital staff. Yes, some of them probably thought my requests were a bit "out there", but I was okay with that. Always remember: you are your and your baby's best advocate. Your team aren't mind readers, but they will typically do their very best to help you have the experience you want to have! My recommendation is to bring up the conversation and talk through scenarios ahead of time. Best of luck to all of the pregnant mamas out there! I'm rooting for you!!