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Cara McDonough

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I Don't Care How My Baby Is Born

Posted: 02/02/11 01:21 PM ET

I know. I do. I should care.

Total apathy regarding my obstetrical choices could result in a huge backlash for the feminist movement, for our collective nether regions. Or something like that.

I'm not an awful version of the fairer sex, I swear. I agree that the C-section rate -- which, in the United States, has increased from five percent in 1970 to more than 31 percent today -- is too high. I'm not a medical expert, but if all those C-sections were medically necessary, it would stand to reason that had those surgeries not been performed, those mothers and babies would have suffered disastrous medical consequences. As childbirth is a common and natural occurrence, I can hardly believe that's true.

The World Health Organization recommends a level of no more than 15 percent of Cesarean section births. That sounds about right. But when my daughter was born in the fall of 2008, I had a C-section, and now -- willing or not -- I'm involved in this discussion.

She was facing up (this is called the posterior position) with her head tilted back and stuck under my pelvic bone and had not descended into the birth canal at all, despite hours of labor and pushing.

I was fine with my doctor's decision and was fortunate that my recovery was easy.

Was mine one of the highly sought after (for purposes of maintaining street cred) "medically necessary" versions of the procedure? I don't know. Perhaps under a different moon or with a different doctor, my baby would have popped right out. Or maybe not. Maybe she would have lost oxygen.

I didn't think about it much until recently. Now pregnant with my second child, and delivering at Yale-New Haven Hospital (which offers both choices), I am faced with the decision of whether to have a repeat Cesarean, or try for a VBAC.

For the uninitiated among you, VBAC stands for "Vaginal Birth After Cesarean," and the most serious risk associated with one is a uterine rupture at the site of the previous incision. According to the most recent reports, as well as my own doctor, the likelihood of this happening is less than one percent. A repeat C-section carries it own risks, as does any major surgery.

At this particular moment in my ever-changing mind, I figure I might as well try a VBAC under the careful observation of the medical team.

But to tell you the absolute truth, I don't care how this baby arrives.

Like every parent on the planet, all I want is a healthy child (boring), and what I find strange about this experience is that I'm allowed -- and expected -- to make a decision regarding this desired outcome. I want someone else to tell me what to do.

Now, back down, tigers! I get that I'm lucky to live in this country, working with some of the best doctors in the world who can make all my specific childbirth dreams come true. Problem is, I don't think about childbirth all that often. Nor do I want to.

No, no -- t's a beautiful thing, etc. It's just that I'm as likely to talk about the beauty of squatting into a strong contraction, recognizing the incredibly hard work my body was doing in the same breath as I am I to speak -- in dulcet tones -- of the beauty of the epidural I had that day.

Listen: I know some of you are going to be mad at me when I say this, but the C-section issue? It's just not my bag. I believe that in this life you choose your battles, and this isn't one of mine.

Like the rest of you, I want to make the right decision, because I'm a strong woman who trusts her body. But then I think about that time I was jogging down a busy sidewalk near my house, tripped on a minuscule crack and went flying face first into the pavement in front of all the morning commuters. So, I guess I don't totally trust my body, if you want to know the truth.

My thoughts are fickle, irresolute. I indulge in giddy natural birth daydreams -- a soundtrack of power ballads as I push my baby into this world. The next second I'm fantasizing about the glorious two extra nights in the hospital offered to C-section patients -- having pancakes for breakfast while maternity ward nurses attend to all our needs.

Perhaps the answer, ironically, is to stay true to this indecision.

In upcoming months, I plan to remain open to the experts' advice. My personal choice is to do whatever the doctors tell me -- to force them to discuss the topic with me as much possible before kicking me out of the exam room because, yeah, I get it -- they have other patients.

I like doctors. What I don't like is getting worked up about this decision when there is a world out there beyond my uterus. But if you've chosen this battle as one of your own, well, sister, fight on.

Mostly, I think we women should be kind to one another in addressing the choices we make about childbirth and everything after. If it's the quiet certainty of a repeat C-section you want because you're scared -- or maybe because of the pancakes -- that's totally understandable. Same goes for the flip side -- if you can't stand the thought of going under the knife again, and you want the quicker recovery time of a vaginal birth.

There is, after all, enough to feel guilty about in the challenging world of parenting. When I start doubting myself, wondering if there was something I could have done better last time (pushed harder? screamed more?), I tell myself, kindly, to please shut up.

I remind myself of what's important and true. That I did -- and am doing -- a good job.

And so, my friend, are you.

 

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01:25 PM on 02/24/2011
There's a great book called Pushed: The Painful Truth About Childbirth and Modern Maternity Care. I highly recommend it if you are undecided about selective C-section or natural. There are huge benefits to baby/mother bonding that come from a natural experience. When I had my child two years ago I wanted a natural childbirth and my OB made it sound like it wasn't my choice. So I left his practice and found an amazing group of midwives and the ONE hospital in NJ that would let them deliver. It's a choice only you can make but have faith in your body... I promise that it knows what to do. At least it does when it's free of drugs to induce or speed up labor. Good Luck... BTW, I had a totally natural delivery despite having my water break 3 1/2 weeks early.
09:44 PM on 02/02/2011
Cara, thank you for describing your calm and thoughtful approach to vbac. Keep talking to your OB. The right decision almost always becomes clear before it has to be made. I am an OB and I agree with you that the c-section rate is too high, but that most cesareans are not tragedies. I believe there are many medical factors that will prevent the c-section rate from ever being 5% again (later average age of childbirth, more multiple gestations, increased rate of obesity and diabetes in pregnancy, and possibly the availability of cesarean section for several generations now) but think that the goal should be a vaginal delivery when medically reasonable. In my opinion one of the biggest factors to consider in deciding on vbac or planned repeat section is how many children you plan to have, as the risks of repeat cesarean, while present for every one, increase significantly after 4.
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Cara McDonough
11:14 AM on 02/03/2011
Thanks so much for this comment, I truly appreciate it. I hadn't even considered some of the factors you mention in the increase in c-section rate, which are really interesting to think about.
07:24 PM on 02/02/2011
I too, had a very posterior baby, meaning I was completely dilated for 20 hours while we worked to turn my stubborn baby. he finally did, and was born naturally, vaginally, and at home. On my birthday :) We went to bed that night as a happy family of 5 and the next morning I woke up feeling like I hadn't even given birth. My recovery was quick and uncomplicated.

Since you've only had a c-section, and I have only had vaginal births, neither of us can compare our experiences to the other. But I didn't want a c-section, despite my "complications" because the recovery time is undoubtedly longer, as are the risks from the c-section in the first place. For both you and your baby.

To each his own, I guess.
09:38 PM on 02/02/2011
I am glad everything worked out well for you and your family. 20 hours is a very long time to have a baby's head engaged in your pelvis while your uterus tries to push it out. You were certainly at risk for nerve and tissue damage that could have resulted in a fistula between your vagina and bladder or rectum. If you are interested in the natural outcome of obstructed labor you can google fistula hospital. U.S. surgeons go to Ethiopia and other countries to train in the repair of complex fistulas because they are so uncommon anywhere cesareans are readily available.
11:51 AM on 02/03/2011
Come on now...Your at more risk for nerve and tissue damage from a cesarean than a vaginal birth. "They" aka Western Medicine, don't consider maternal positioning in regards to posterior babies. It's important for women to be upright and moving through their labor unmedicated in order to help baby with cardinal movements...not strapped to a bed, numb from the waist down. Doctors answers to OP babies is just to cut them out. Check out www.spinningbabies.com for some alternative options for posterior babies. To say that the natural outcome of obstructed labor is fistulas is...ummm...crap (no pun intended). Don't you think the reason that 3rd world countries have a high fistula (complex or otherwise) might have more to do with 1) little to no prenatal care 2) unsanitary birthing conditions 3) unskilled birth attendants 4) little to no postpartum care and 5) pregnancies spaced too close together? Have you been to Africa and seen their Hospitals? Seen the way the women are treated? It's no wonder their maternal/infant mortality & morbity rates are so high. Amnesty International released a paper entitled "Deadly Delivery The Maternal Health Care Crisis in the USA". http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf The good ole US of A should be ashamed of it's record. A cesarean is not 100% safe, it has very real risks for women and babies and women need to be aware of all the evidence-based (not fear-based) medical choices for them.
12:14 PM on 02/04/2011
His head was no more in my pelvis when I was complete than he was for the preceding 4 weeks that rounded out my pregnancy. Also, the entire reason I was complete for 20 hours was because my body was NOT trying to push the baby out. I never said I was pushing for 20 hours, that would be more risky, for sure. But my lovely son dilated my cervix in a very posterior (sunny side up) position, and then needed to turn anterior so that he could come out. Some babies can come out posterior, but I am small waist-ed (I've never been larger than a size 4) so that was the only way he was gonna come out. It was not a case of obstructed labor, although had I been in a hospital with my movement restricted or possibly an epidural, it would've been a c-section, no doubt.

Many births don't look like the ones in the textbooks, and that's okay. If mom and baby are thriving, let it be!

BTW, to those interested, my reproductive organs are still in perfect working order. No recto-vaginal fistulas to speak of.