Thursday, January 15, 2009

Trapped

When I first got pregnant this time, I would often joke that I didn't care if they took this baby out with a melon baller, as long as she and I ended up healthy. Turns out, what I really meant is that I care really a lot about how, exactly, this baby is born. I seem to have skipped right past "being grateful that I even get to have another child" and gone straight to "fretting that this birth will be as bad as M's."

M's birth was, to put it mildly, unpleasant. To start, my water broke late in the evening, before I had a single contraction. We were advised to go straight to the hospital and, like idiots, we complied. As it happened, the hospital was insanely busy that night, and not only were all of their L&D rooms full, but so were the triage rooms, the family rooms and the overflow rooms.

(have I told you all this story before? I can't remember, and I'm too lazy to look it up. In case I did, here's the condensed version: no room (just a bed in the c-section recovery area), so no sleep, uncomfortable, OB antsy about slow progress, pictocin, epidural, more (and more and more) pictocin, push, push, push, push more, vacuum, push more, vacuum some more, c-section).

The upshot was that M was born around 2:15 am, after 30 hours of labor and a c-section. The Boy got to hold her for a few moments, but I was too busy throwing up to be able to touch her. Then they took the baby and wheeled me back to recovery, and The Boy spent the next two hours watching helplessly as M lay alone and largely unattended in the nursery. Hospital policy, it turns out, doesn't allow dads to have access their babies until Mom is done with recovery and moved to her post-partum room. It was 4:20 am before I laid so much as a fingertip on my daughter. To this day, I'm angry that M spent the first few hours of her life alone, and more than a little convinced that this had something to do with her jaundice and subsequent difficulties nursing.

So this time around, I'll do anything to avoid that long post-birth separation from the baby. That's the entire goal, right there. So, working backwards in a cause-and-effect manner, we've decided that the best way to accomplish this goal is:
a. Avoid repeat c-section, by
b. doing what we can to increase chances at a VBAC, which include:
c. Avoid epidural;
d. Ask for as much freedom of movement as possible during labor; and most importantly;
e. DO NOT RUSH TO THE HOSPITAL. STAY HOME AS LONG AS POSSIBLE, BECAUSE ONCE YOU"RE THERE, THE INTERVENTION TRAIN WILL LEAVE THE STATION WITH YOU STRAPPED TO THE ENGINE IF NECESSARY.

So The Boy and I worked up a nice little birth plan that basically says all of this stuff. I've been mentioning it all to the doctors for at least the last month, but this is the first time one of them was confronted with it in writing. First, she giggled. Then, she guffawed. And then she instructed me that I was to get myself to the hospital the split-second one of the following happens:
a. My water breaks, even if I haven't had any contractions; or
b. I have any painful contractions. That's right, any. No matter how few, no matter how far apart.

She also noted that once I get to the hospital, continuous fetal monitoring is a non-negotiable, and that if I refuse an epidural, then most likely they'll just give me general anesthesia and c-section me the second they detect any hint of fetal distress. So, basically, she wants me to go to the hospital before I'm even in labor, so I can be chained to a bed immediately and forced to remain motionless for the duration of my labor or until they manage to scare or browbeat me into another c-section, whichever comes first.

And we wonder why the c-section rate is hovering close to 30%? Patient's choice, my ass.

Now, I know my doctors mean well. With any VBAC, there is a real (if minuscule) chance of uterine rupture, and short of forcing me outright to have a c-section, the best way to avoid even that tiny chance is to have me where they can see and control me at all times. I totally understand where they're coming from.

At the same time, though, I feel trapped. A c-section is major surgery, complete with a long (ish) recovery time, tight restrictions on my ability to care for M for weeks afterwards and the very real (but also rare) possibility of complications with long-term consequences for both me and the baby. To me, the downsides far outweigh the less-than-1% chance of uterine rupture that comes with a VBAC. But getting the doctors to admit to any downside at all is next to impossible (to the contrary, one doctor actually told me that recovery from a planned c-section is easier and more convenient than recovery from a normal birth). It's clear that they want me to have a c-section, and while they claim to be willing to let me try for a VBAC, they will do everything within their considerable powers to back me into a corner where a c-section becomes unavoidable.

So, I'm about to do something that scares the hell out of me. For the first time in my entire life, I'm going to ignore an order from someone in a position of authority. I'm going to smile and nod when my doctors tell me I need to get to the hospital before labor begins, and I'm going to stay at home, instead. I have no intention of arriving at the hospital pushing, but neither am I about to spend my entire labor there, where I can be pushed and hurried and bullied into compliance with interventions that may or may not even be necessary.

This was not a decision that was made lightly. I've spent countless hours trying to get my hands on every study I could about the risks of VBAC and the risks of c-sections. The Boy and I stayed up into the night discussing it last night, and we finally came to a decision that I think we can live with. Once we're at the hospital, I will submit to the monitoring and the IV, but I hope that by then, I'll be far enough along to make it to delivery without any problems.

I'd be lying if I said I was comfortable with what we're about to do. The thought of risking this baby, even the tiniest bit, makes me physically ill. But I also don't see much of a choice here. Either I submit to an elective c-section, or I go to the hospital and submit to the exact same sequence of events that resulted in my last c-section (minus the pictocin, but that just makes the c-section trigger fingers even itchier). I don't honestly see any chance of my having a successful VBAC if I do the good-little-girl thing and do what I'm told.

So now I'm a rebel. A really reluctant, scared, pissed-off, trapped rebel. Wish me luck.

6 comments:

K said...

Best of luck! I agree with you 1000%! Stick to your guns and as long as you, dh and doula are on the same page, it's gonna be harder to be bullied by The Man. ;o)

Rachel said...

I'm so sorry you have this dilemma. I was really worried about being pushed into a similar situation because of my (largely bogus) classification as 'high risk.' I also don't understand at all why your ob/gyn would be pushing an epidural - it's for pain relief, and nothing else, as far as I understand (and it is very, very rare to have such an emergency c-section that they don't have time to put in a spinal and have to go with general).

I was just wondering if you've hired a doula or can find a midwife or doula who you could explain the situation to and would be willing to 'consult' with you over the phone when you're in labor. I'm sure you've read enough to know the warning signs of when something might be wrong, but it might still make you more secure in your decision to have someone who has seen plenty of VBACs answering questions during the process and reminding you of any warning signs of a complication.

I really hope that you are not coerced into another c-section unless it's the only option.

Paranoid said...

I do have a doula. I figured there was no way we'd be able to stand up for ourselves without outside help, so we hired her a few weeks ago. So far, she's been wonderful, and I hope that her presence can at least help me remember that I do have choices.

Harrison said...
This comment has been removed by the author.
Morgan said...

I think you're off to a good start for having a VBAC by making sure you avoid getting induced (which most doctors will not do pitocin for a woman that has had a prior c-section), and by laboring out at home for a while.

I hope you get that VBAC! I hear the recovery is SO much easier than a c-section!

The Girl Next Door said...

You Go Girl. You are brilliant and thoughtful and have made an informed decision. I'm here cheering you on!