Showing posts with label C-Section. Show all posts
Showing posts with label C-Section. Show all posts

Friday, April 22, 2011

I found my "kind"

::Smile:: I've gained quite a reputation at work for being mom-and-baby friendly.

The L&D nurses told me last weekend that they love when I come to their deliveries. If a baby comes out pink and crying, I bring extra baby blankets to the side of mom's bed and monitor the baby while mom holds baby on her chest. I let mom hold baby at least 5 minutes. It's really not that long! But... unfortunately... most other newborn nurses want the baby on the warmer before the baby is even one minute old. One of the L&D nurses told me that a baby nurse actually starts tapping her foot if the baby lingers "too long" with the mom. This just disgusts me.

Another bad practice that I am trying to reverse is the length of time the baby is on the warmer away from the mom. Some of the older nurses do all of their charting at the same time as their hands-on care, which practically doubles the time the baby is on the warmer. I've seen some nurses selfishly keep the babies on the warmer until 35 or 40 minutes of age. That's a heck of a long time, considering the baby goes up to the nursery at 2 hours of age for the first bath (another habit that I hope to change one day!). I always try to get the baby back to the mom by 13-15 minutes of age (and that's after the mom holds the baby the first 5-6 minutes). This way, I can keep the baby with the mom as much as I can while also doing all the tasks that my unit expects me to do. I try to be as quick and efficient as I can!

I also always try to give the mom a "sneak peek" of their baby after a cesarean. I remember with my c/s, I didn't see my baby for at least 25 minutes after birth. I saw his picture on our camera and his footprint before I actually saw him. That was a loooong time to wait. I figure that footprints, bands, and meds can wait until baby has been seen, touched, and kissed by his mama!!! As soon as baby is "stable," I will wrap him in a blanket and take him to mom for a minute or two before I bring him back to the warmer to do all my "stuff". Even though it seems like such a simple thing, I believe that this really goes a long way for post-c/s bonding!!!!

So, anyway, back to the main point of this post. Over the last few weeks, I've gotten into several great discussions in L&D about natural childbirth, breastfeeding, skin-to-skin, and bonding. I've been able to pick out a few fantastic L&D nurses who really are on the same page. I've had some really beautiful births with them. I'm glad that I really stand out as being "gentle-birth-friendly." After spending four years in the newborn nursery, where the majority of nurses have never breastfed and no one seemed to understand my desire to VBAC ("why don't you just have another C/S?" ::sigh::), it's good to know that there are some other nurses who "get it." They understand the birth is such a valuable and important experience for the mother. It's a time she'll never get back. We have to protect that time and treat it as sacred and special.

There are so many practices that I would still love to change in our hospital, but I'm glad my "baby-steps" have not gone unnoticed, and I hope that they catch on! The moms who graciously let us into their birthing space deserve that much from us!!!

Monday, March 21, 2011

A typical day at work

I work as a newborn nurse at a busy, urban, level III NICU hospital.

Curious as to what I actually do? Read on:

(warning, long and detailed post!)

I really love my job. I am so lucky to have the privilege of meeting fresh new babies every day.

When I am the newborn nurse assigned to cover deliveries, this is what a typical day looks like: My job is to check equipment for function, stock supplies, and review prenatal records. I'll update neonatology as necessary (a neonatologist or neonatal nurse practitioner will attend any "high risk" delivery- breech, meconium stained amniotic fluid, prolonged decels on the monitor, any delivery less than 37 weeks gestation, insulin dependent diabetic mother, potential shoulder dystocia, compound presentation, vacuum or forceps, etc... ) and, of course, attend births!

When I first get to work, I will receive report for the previous shift RN about who is laboring-- any important medical history, how far dilated she is, how far along her pregnancy is, who her doctor is, etc. She will hand me the pager so that L&D can page me to an eminent delivery if I'm not on the floor.

If there aren't any women close to delivering, I will first go and check my equipment:
1.) make sure the neonatal code cart is locked and the transport isolette is stocked with an MIE bag and mask, full O2 and air tanks, has a full battery, and is pre-warmed to an acceptable temperature.
2.) check the two operating rooms and then all ten labor rooms for functioning wall oxygen/air and blender as well as functioning wall suction. I also check equipment in the warmer base drawers:
MIE bags and a full term and a premie O2 mask, suction catheters (two of each size- 14f, 10f, 8f, 6f), a stethoscope, 2 endotracheal tubes in all the following sizes: 2.0, 2.5, 3.0, 3.5, 4.0, laryngoscope blades (3 sizes) and handles, extra batteries for the handles, a MSAF kit (meconium aspirator, ET tube, stylet, and 14f suction catheter), CO2 detectors, OG tubes for lavage during codes, and of course diapers, hats, extra paperwork, tape measures, etc...
3.) check to make sure there are enough baby cribs in the closet
4.) check to make sure there are enough security sensors for our security system

In between all of this running around, I continually double check the labor board to see how far dilated our laboring moms are so I can try to manage my time efficiently. I will try to flag down the L&D charge nurse to get an updated report on any new admissions.

I will then flip through charts to review prenatal records for any pertinent data: full term?, Gravida/parity, age, relevant medical history, HBSAG and HIV status, rubella titer, blood type, urine toxicology results, etc. I will check to see if the mom will breast or bottle feed and who her pediatrician will be.

I will then try to make up identification bands for the baby... one less step to complete at the actual birth!

Usually all of this leg work gets "interrupted" by a birth or two. In this job, you've got to stay organized and be flexible!

If there are no births (rare!), then I go back up to the nursery to assist with assessments, teaching, admissions, blood work, charts, or anything else they might need.

Once I do get paged to a birth, I go into the room and set up my supplies. I like to have everything as ready as possible so that I can get all of my baby stuff done as fast as possible after the birth so I can hand the baby back over to the mom pronto. I will first turn on the radiant warmer to heat up, turn on my O2 and my suction, set up my baby blankets on the warmer, plug in the scale, set up my erythromycin with gauze and sterile water for cleaning the baby's eyes, draw up my vitamin k for the IM injection, get out an ink pad and a soapy gauze to clean the ink off, and get my transponder attached to a cord clamp. I get all my paperwork out and ready. As I'm doing this, I'm constantly assessing the situation in the birth room: is the fetal monitor on? How is the baby tolerating pushing contractions? Is the baby crowning yet? Will there be a vacuum or forceps? Do I need to page neonatology? Is there a nuchal cord? Is a tight cord clamped and cut before the birth of the body?

Once the baby is born, I hit the timer button on the warmer (for resuscitation purposes if necessary) and double check the time of birth. Most of the time, the baby is born with a lusty cry. If the baby is crying, I know that it has a good heart rate and good respirations. And I can relax a little and just let the mom enjoy her baby for a few minutes while the L&D nurse is stimulating and drying the baby on the mom's chest. After a bit, I'll ask the mom if its ok to borrow the baby for a few minutes... I'll take the baby over to the warmer and do a very quick assessment - pink? crying? good tone? Head to toe look-over. Then I'll ask the dad to get out his camera as I put the baby on the scale to get a quick weight and length. Back to the warmer. Vitamin K IM injection in the thigh, Erythromycin eye gel in the eyes. Complete the identification bands with the time of birth and sex of baby. Footprints. Have L&D nurse double check my ID bands before putting them on baby. Put security tag on baby. Finish measurements (head, chest, abdomen circumference). More thorough head to toe assessment with gestational age exam. Quickly write down anything out of the ordinary so I don't forget! Quick set of vital signs. Triple wrapped with hat (or SKIN TO SKIN with mom with warm blankets over both if she seems up for it). Hand baby to mother for breastfeeding!!!

All in all, I have baby at the warmer for 6-10 minutes before giving the baby back to mom. I'm usually so quick that I am finished with the baby before the mom's perineal repair is finished. I pride myself on being quick... many other nurses take as long as 25-30 minutes! That's a loooong time to be without your baby after birth! Some of these tasks must be done in the delivery room (footprints, bands, security tag, baby meds, vital signs) and the other things (gestational age exam and measurements) only take a minute to do and its really helpful to the nursery to get them done and it helps determine whether or not the baby will need to be on hypoglycemia protocol. Sometimes, if things are really crazy on the unit, I can omit these two things, but I often just throw it in anyway... it doesn't take long.

Once the baby's handed off to the mom, I help her with breastfeeding and tell her to hit the call light of she needs anything... then I clean up my mess (I usually just throw all my soiled linens and trash on the ground since I'm working so fast) and leave the room to finish paperwork. Charting takes a good 10 minutes to complete.

Then, I have to check vital signs on the baby every half hour (and check blood sugar if applicable) before bringing the baby up to the newborn nursery at two hours of age. This can become quite a busy task when there are multiple babies born on the floor!

There are obviously variations to this routine depending on the baby (Premature? Respiratory Distress? Immediate admission to NICU) or the delivery. In a c-section, I will have all of my equipment and supplies set out/turned on and then put on a sterile gown and stand near the sterile field next to the mom's legs. After the baby is removed and the cord is clamped and cut, the obstetrician will hand me the baby and I will take the baby immediately to the radiant warmer for drying, stimulation, and a quick head to toe assessment. If the mother is awake and seems interested, I will (if baby is stable), quickly wrap baby in a blanket and take him/her over to the mom for a minute so she can see the baby right away. I believe that this simple act goes a LONG way to help with bonding in cesarean deliveries. Oh, how I wish I could have seen my baby so soon after my c-section! Then, I'll return the baby to the warmer to complete my "tasks" before wrapping the baby and handing the baby off to the father. Unfortunately, I cannot leave the OR without taking the father and the baby with me (I am the one responsible for the baby), and if the unit is busy, I cannot linger for long. After 10 minutes or so, I lead the dad and the baby to the recovery room to wait for mom.

If the baby warrants some resuscitation, I follow NRP guidelines. Thank goodness, most babies only need a little bit of free flow O2 if anything at all. Thankfully, neonatology is always only minutes away and the L&D nurse is always there if I need a hand with resuscitation.

It is so amazing to have the honor of being in attendance at so many births. Although work is extremely busy and very physically demanding, I absolutely love it. I am hoping to constantly improve my practice to allow more skin to skin and sooner to facilitate bonding and early breastfeeding. I also hope to rub off on more nurses... I think I'm the only one who does this regularly!

My job is incredibly rewarding!





Friday, September 17, 2010

weeping

I had a sudden "attack" of weepiness yesterday regarding my c-section. It has been two years. When will this end?

It's amazing to me how completely and totally that one day has changed my life. I get so frustrated when people just brush cesareans off like they are no big deal, that they are "just another way to give birth." WRONG! I didn't birth my son. He was ripped from me. Unnecessarily. It isn't just the section that frustrates me. It's all the events that led up to it. If I hadn't gone for my biophysical profile, they wouldn't have noticed the "low fluid". AFI is a tricky thing to measure by sonogram. If the fluid is on the inside of the uterus, between the baby and the interior wall, it won't be seen and won't be measurable by sono. It just makes me so mad that there was this tiny excuse that they found to induce me. I had a perfect pregnancy and I was young and healthy. And I am so mad at myself for letting them do it. I wanted to leave, but they manipulated me by saying I would be "discharged AMA" and that "if anything happened to your baby, it would be your fault." Disgusting.

The induction led to the epidural, which led the the c/s. I know from my second birth that I had absolutely no problem at all birthing a big baby. I know I could have done it. Why did I let them mess with my body????

My son's birth broke me. I felt assaulted and victimized. Strapped down, naked, to a metal table with bright spotlights shining on my most private parts while a dozen people file into the room. A drape is set up in front of me-- was it to shield me from the surgery or was it to dehumanize the section for the surgeon? I felt so alone as I was cut open, my uterus taken out of my body.

Even before the actual surgery, when I was pushing in the labor room-- there were two nurses, a midwife, an OBGYN, and a med student all yelling at me to "PUSH," again with my naked body exposed to the world with spotlights and an open door. Strangers could have walked right in. How humiliating. I didn't at all feel like a person. I felt like a just another patient on a birth assembly line. "Let's just get her delivered!"

This DISGUSTS me! I thought that my beautiful birth with my VBAC victory baby would have helped me heal. But, now I know how AMAZING natural birth can be. And I feel even worse that I missed out on that with my son. That experience was stolen from me. And instead, I struggled with a very difficult physical and emotional recovery. And... in some ways, I will never recover.

Friday, August 20, 2010

Patient Story: Repeat C/S gone wrong

I met a very nice couple who had recently birthed their second baby. The baby was perfect and just so sweet. The mom, however, was very very frustrated with her experience and when I found out why, I was so so sad for her.

She had a routine scheduled repeat c-section. Not an emergency. No rush. It was supposed to be "controlled" and "relaxed". However, during the surgery, the mother apparently overheard her OB telling the resident "No! Stop! You're cutting too much!" which, as you can imagine, was very distressing for this poor mother who was strapped down, helpless, to the operating table. Apparently, the bladder was cut. In a botched attempt to repair the damage, the bladder was accidentally sutured to the uterus (how does that happen????). They didn't realize the mistake until the day after the birth, when the mom complained of tremendous pain and had terrible hematuria. Her foley bag was bright red with blood. They took her back in, opened her back up, and fixed the misplaced suture. This was quite the traumatic experience for the mom, who then had to pump and dump her breast milk because the antibiotic she is on (adding insult to injury).

I just feel so sorry for her. This never should have happened.

Cesareans are major surgeries. Risks are very real.

Thursday, August 12, 2010

What are Glory Birthings?

David Crowder (my favorite musician) has a song entitled "How He Loves" on his latest album called Church Music. While I was worshiping to this song last week, I was struck by how this song reminded me of my VBAC and I was just completely overcome with emotion, as I reflected on how merciful the Lord was to me by giving me everything I prayed for for this birth.

Here are some of the lyrics:

He is jealous for me,
Loves like a hurricane, I am a tree,
Bending beneath the weight of his wind and mercy.
When all of a sudden,
I am unaware of these afflictions eclipsed by glory,
And I realize just how beautiful You are,
And how great Your affections are for me.

And oh, how He loves us so,
Oh how He loves us,
How He loves us all

Yeah, He loves us,
Oh! how He loves us,
Oh! how He loves us,
Oh! how He loves.


I just kept thinking about labor- how intense and exhausting it is. It's like being caught in a storm.... but then as the baby is born:
"...all of a sudden,
I am unaware of these afflictions eclipsed by glory,
And I realize just how beautiful You are,
And how great Your affections are for me."

Eclipsed by Glory! How awesome is that? When my sweet victory baby was born and immediately placed on my chest, and I felt her warm wet skin and heard her lusty cry, it was absolutely glorious! The past 15 hours of hard work and discomfort were washed away by the strong wave of relief, pure joy, exhilaration, and deep love for my baby that poured over me.
In the wake of this intense glory wave, I was just left in awe of my God and his incredible design. There was nothing to do except praise Him.

Glory means:
1. praise, worship, and thanksgiving offered to God
2. magnificence; great beauty
3. a thing that is beautiful or distinctive; a special cause for pride, respect, or delight

Glory Birthings are the ones that cause you to give praise. They are magnificent and beautiful. And they cause great delight!

Glory Birthings are the ones that leave you so elated and empowered that you just feel like singing. All the time. 8 weeks after my VBAC, and I am still flying!

Also... less noticeably, Glory Birthings are the ones that change and shape us into something beautiful, even if it hurts. My first birth was very difficult... I suffered from PPD like so many other women I know who have experienced traumatic births. It is deeply unfortunate to have to experience such hardship, especially when many times it is unnecessary. Two years later, though, and I am finally starting to see this birth as a Glory Birth, too. It has taken a long time and lots of prayer, but the arrival of a sweet and glorious newborn babe, the result of a glorious pregnancy, eclipses all affliction that I experienced to get him here. And I am SO thankful! I am starting to see myself not as a victim of an unfortunate culture of fear in our health care system, but as a mother who loves her child so deeply, that she would lay down her life and give up her body for his well being.

I'm not saying that we should just forget what happened to us and just let unnecessary surgical births continue to occur- oh no! We need to use our experiences as catalysts for change. We also need to stop wallowing in our despair and start helping other moms finish their grieving and heal, and to help new moms prevent the grieving from starting at all.

My prayer is that every mom can see her birth- no matter what happened- as a Glory Birth! We, as women, are the crown of creation. Our bodies can do remarkable things. Let us reclaim our births, our bodies, and our emotions! Even if our hopes for a birth were stolen from us, let us not let the glory, the magnificence, of our accomplishments (the beautiful children that we created) be stolen as well.

Both of my births were incredibly transformative and integral parts to my story. They were both glorious. And I praise God for both.

Tuesday, August 10, 2010

Judah's Birth (or how I became a "VBAC candidate")

[written when 28 weeks pregnant with my second baby]

I don't really like talking about Judah's birth, because a lot of people don't understand my intense emotional reaction to it. Many people say "well, just be glad that you have a healthy baby". I am so glad! But it is so much more than that... Contrary to what many OBGYNs may think, C/S is not "just another way to have a baby". It left me deflated and disheartened. Judah's birth was by far the most difficult thing I've ever had to face.

Now that my abdomen is "blossoming" (the nicest way anyone has ever said that I'm huge in my midsection), several people have asked me if I'm planning a repeat c-section or if I'm allowed to try for a vaginal delivery with this baby girl. I tell them that I want to avoid another C/S like the plague!

Judah was born on August 5, 2008. Here is his birth story:
I had just graduated from nursing school, and I was a brand new registered nurse working in the newborn nursery. As part of my schooling, I had been witness to probably about 60 vaginal births and about 30 c-sections in the regional perinatal center where all the "high risk" mothers get sent to deliver. I had seen A LOT. I knew what could happen, what could go wrong. But I had also seen "perfect" births where everything went as it was supposed to. I was idealistic. The pregnancy had been amazing and I had no reason to believe I wouldn't have a pretty standard vaginal birth. I spent the last few weeks of my pregnancy (during the late night periods of insomnia) researching clinical journal articles on the best pushing techniques, the pros/cons to epidural use, how to avoid episiotomy... My plan was to labor at home as long as I could, and then hit the hospital for the delivery. (In this area, there is no birth center and only one midwife who attends home deliveries and I was unaware of her practice at the time.) I wanted as natural a birth as possible.

Well... that didn't happen. 4 days after my due date, I was sent to the hospital for routine "overdue" fetal testing. Judah seemed perfect-- except that they couldn't get a good read on my amniotic fluid levels. I hadn't had any leaking (when you're past your due date, you are on hyper-alert for ANY sign of impending labor! Trust me, I would have noticed!) and my levels were great only a few days prior. So, I wasn't worried. But they were. I was escorted immediately to labor and delivery to begin an induction. I wasn't even allowed to go home to shower or get my hospital bag. SO not cool. I was very disappointed that I'd have such a medicalized labor, and I knew how intense induced labors could be (I had witnessed dozens of them). I asked the nurse if I could just go home, and she told me that I would have to check out "AMA" and "you don't want to do anything that could hurt your baby! You'd never forgive yourself! It looks like today's the day!" I felt hopeless and helpless already.

I was admitted at 2pm Monday. I was considered "high risk" now because of low amniotic fluid levels (oligohydramnios) and therefore had to be on constant fetal monitoring. Let me tell you, that was a TOTAL DRAG. My belly skin was impossibly stretched and very sensitive. Those monitors were tight and itchy and uncomfortable. And... I couldn't move around very well. I didn't get my cervidil placed (to soften the cervix) until 9pm that night! (so... yeah... 6 hours of waiting). Then they told me to sleep. haha. Yeah right. The labor/delivery bed was incredibly uncomfortable, and I had a nurse come in every 20-30 minutes or so to reposition the fetal monitor.

The next morning came... and again I had to wait. I was supposed to get the pitocin drip started at 10, but it didn't start until after noon. But, oh man, I immediately began to have intense contractions. Isaac, my husband, applied counterpressure to my low back, and my mom read scripture verses to me. It was painful, but bearable.... I thought, if this is how bad it gets, I can totally do this. And I began to get really excited about Judah's arrival. In between contractions, we played "bananagrams." I wanted to stay as positive as possible and make the most out of an unfortunate situation.

Then, at 4:30, my water broke with a loud "POP" in the bathroom. The contraction immediately following was a thousand times more painful than anything I had ever experienced. I couldn't breathe. I was by myself in the bathroom, and I felt I couldn't stand, walk, or even call out for help. The contraction mercifully faded and I stumbled out of the bathroom, dragging my IV pole, as I huffed and puffed through shallow breaths to my husband that "water broke... call the nurse." Another MONSTER contraction hit and again, I felt totally helpless against the relentless pain that seemed to know no bounds. I felt the entirety of every contraction in the front, across my entire pregnant belly. It felt like it was on fire. It was this incredible tightness, like a boa constrictor was squeezing the life out of me. When the contraction passed, I whispered "epidural".

When it normally takes about 15 minutes to have the epidural catheter placed, mine took 45. It was originally placed in a "bad" spot which left me with ringing in my ears, heart palpatations, and a metallic taste in my mouth. Those things are never good. Sitting there on the bed, haunched over my squeezing abdomen, unable to move for 45 minutes was literally torture. But the end result-- let's just say I had a very good epidural!

Right before the epidural was put in, I was at 4cm. An hour later (and much needed rest), I was at 10! I couldn't believe it! I was completely elated and rejuvenated! I was so happy. Because of the epidural, though, I couldn't feel the urge to push. So I requested to let the baby passively descend before I tried.

Right before 8pm, my drill-sergeant for a nurse told me I had to start pushing. It was right after shift change, and they didn't feel like waiting any longer. I hated being that I felt so out of control and was being bossed around. I asked if I could push on my side, and she said "you can try for 15 minutes, but after that, if its not working, you're going to do things my way." Well, needless to say it wasn't working. I couldn't feel the contractions, so I didn't know when to push. I felt very ineffective. Apparently, Judah's head had come down, and Isaac told me later that he could see his little head with his dark shiny hair, but his head kept hitting my pubic bone and was getting stuck. The nurse had me lay flat on my back and pull on the end of a knotted bedsheet that went up over the birthing bar they had set up on the bed and was being held on the other end by a medical student (that poor student!). I was supposed to pull against the sheet in a tug of war each time I pushed. If anyone ever asks you to push in this position, SAY NO! It was awful. I had terrible heartburn from laying flat on my back and my shoulders and arms were tremendously sore for days afterward. Anyway, I pushed like this for another 2 1/2 hours. That's when the hospitalist midwife that was managing my labor said that I should be examined by the attending physician and that we might have to use a vacuum (did I mention that my own doctor never came?). The attending OB came in, did a quick exam, and announced that the baby was posterior (the back of the baby's head should be facing up, and the midwife told me all along that Judah was like this -"occiput anterior." But now, the back of his head was facing down... How the heck did he get so twisted during pushing? Laying flat on my back and not being able to move because of the epidural was probably the worst thing I could have done). The doctor tried to manually rotate his head during the next contraction, but when he did that, I gushed some meconium-tinged amniotic fluid (I had originally ruptured clear), and the monitor showed decels (the baby's heart rate was showing distress). So, the next thing I hear is "emergency c-section."

At this point, everything gets really hazy in my memory. I remember feeling so totally disappointed and helpless, then angry, and then really really numb. I got prepped quickly, and then I remember staring at the ceiling tiles, totally limp, wondering if Judah's birthday would be August 5th or 6th as they wheeled me to the OR. Is this really happening? It was now about 11:30pm.

When I was strapped down to the OR table, the anesthesiologist put an oxygen mask on my face, and clamped the nose piece so tight around my nose, that it was completely plugged. I felt like I couldn't breathe and began to hyperventilate. I also began to feel nauseous, and so the anesthesiologist (who in my opinion was a complete jerk with zero empathy... he played on his iPhone the entire surgery) tightly held an alcohol swab under my nose. I struggled to get away-- it was already hard to breathe without this guy holding my face down like that. I kept yelling "stop that!" and he just cooly responded with "I heard somewhere that this helps with nausea." Great. Thanks. At this point, too, I began to get "the shakes". I guess it's from all the adrenaline. My whole upper body began convulsing. It didn't stop until about an hour after the baby was born.

The doctor used his prickly tweezers to test the anesthesia. "Can you feel this?" "YES!" I said as I felt the sharp poke. Adjustments were made... "How about now?" "YES!" The anesthesiologist jerk said "No, you can't feel that!" And I screamed at him "YES I CAN!". More adjustments were made and I felt more and more numb.

Two of my friends from the nursery (the unit where I work) were suddenly at my side. Our evening shift ends at 11, and they saw that I was having a c-section, so they came to join me and support me. I'm telling you, they were lifesavers. Donna held my hand while Jen held that stupid O2 mask off my nose so that I could breathe. Isaac was there, too, praying for his poor wife who was just falling apart.

Everything was happening so fast. I heard someone say that they were going to push the baby back up (I guess all the pushing just lodged him in between my pelvic bones, but because of his positioning, I wasn't able to push him out). A bunch of shuffling... then some metal instruments clanging back against the tray. Then the doctor yelling to his assistant "NO, NO! Not YET!" which is something no person should ever hear during surgery.

Nothing can ever prepare you for the PRESSURE of a c-section. Contractions stop when they numb you, so after the incision is made, the surgeon and assistant put their body weight on top of your belly to push the baby down and out of the opening. Although I couldn't feel "pain", this pressure was enormous. I felt like an elephant was using me as a chair. Meanwhile, I'm nauseous, exhausted, have heartburn, am claustrophobic from that stupid O2 mask, and my upper body is still convulsing. This was definitely the worst experience of my life.

11:44pm: I didn't hear Judah cry. The first sound I heard when he was born was gasps from everyone in the room over his size! "Oh my gosh, Sigrid, you birthed a toddler!" That is another thing that no new mom should hear right after the crazy birth of her precious little baby. [Note to hospital staff: when a baby is first born, no matter what, you should comment on the baby's cuteness! Please, for the poor exhausted mother's sake!]

Because of the meconium, the neonatologist was there at the baby warmer. It was a few minutes yet until I heard his lusty cry. I couldn't see anything. The first visual evidence of my baby that I saw was his ENORMOUS foot print that someone brought over for me to see. At this point, exhausted and disheartened, I illogically began blaming the baby for everything that happened. My poor husband who was so scared and silent this whole time, excitedly brought the camera over to show me a picture: "Do you want to see the baby?" "NO!" I yelled. At that moment, I didn't want anything to do with him. I was so angry at him for everything he put me through. Those 10 minutes of irrational baby-rejection gave me so much guilt in the months following his birth. But at the time, everything was backward and crazy. I was no exception.

What seemed an eternity later, I was wheeled to the recovery room. I was exhausted... and still shaking. It was impossible for me to hold my baby. I dozed in the recovery room as my mom, dad, sister, mother-in-law, and husband passed the baby back and forth to each other. I groggily heard someone ask about me: "how's she doing?" "She's sleeping," my husband said. In reality, I was laying in bed, numb literally and emotionally, going over everything that had just happened in my mind. How did this happen? What did I do wrong?

My monitors kept alarming, but I was by myself in the room. Where was the nurse? I began hyperventilating, which caused the alarms to sound even louder. I felt so alone. So abandoned. Everyone wanted to see the baby. It wasn't about me. My bitterness toward the baby escalated.

Finally, the baby nurse (one of the nurses I work with) came in to the room and said that if I wanted to nurse the baby, now was the time. I almost started crying. After all this, I was supposed to feed him, too? The shaking in my arms had finally subsided, and Judah was handed to me. He was crying. This was the first time I got to hold him... he was almost 2 hours old. I remember thinking that his nose was too big for his face, but his eyes were incredibly beautiful. His mouth pulled back a little bit as he cried, and I could see that he had dimples. DIMPLES! He was so handsome. My bitterness slowly began to fade as I instinctively put him to my breast and he immediately latched on. I wept. Isaac was standing by my side.

Less than 10 minutes later, the nurse came in and said she had to take him to the nursery because his blood glucose was low. As a neonatal nurse, I totally expected that to be the case. Judah was 9 lb 6 oz afterall!

Then, I was alone again. I missed my baby. For the first time in 9 months, he wasn't with me. My nurse suddenly reappeared and gave me a quick sponge bath. I could finally wiggle my toes. The numbness had been, ironically, very painful. I felt completely paralyzed from the belly down for almost 3 hours after the surgery, and I remember that for two hours, I had just stared at my toes, willing them to move. They couldn't. It was such a weird experience. This had been the worst day of my life. I had lost control of everything-- even my toes.

I was wheeled to my postpartum room at about 4:30am. We stopped by the nursery first. Judah was still on the warmer. He was the biggest baby in the nursery. But he was my baby. He was beautiful. I loved him. It was so surreal.

The floor nurses hadn't mentioned to me anything about pain meds. I just assumed that they would be on a schedule at first and they would just give them to me when I was due. I didn't know that I had to request them. Consequently, the next 12 hours went by and I didn't have anything for pain. Once my epidural wore off, I tried to sit up in bed to nurse Judah and I literally screamed out in pain. Pain from my incision, but also tremendous pain in my shoulders from pulling that stupid sheet while pushing. My entire body ached; I felt like I had been hit by a car. A very apologetic nurse came in and gave me some medicine and told me that I had to request my pain control. I did just that... every 4 hours I rang the call light for my percocet. There was NO WAY I wanted to feel that again.

I got no sleep in the hospital. I was totally in love with my baby. I foolishly kept him in the room most of the time. He was a hungry baby, and my milk didn't come in until he was 4 days old. I nursed him every 2 hours around the clock. I was so exhausted. By day 3, I started to melt down. I called my mom and told her that I didn't want any visitors at all that day. I needed to just rest. By the time we were finally discharged Saturday evening at about 4:30 pm (I was admitted that Monday at 2pm), I was literally an emotional wreck. I cried almost the entire night. I called my pastor's wife and asked her to pray over me. I didn't know what else to do. I was so overwhelmed with emotional and physical hurt.

I struggled with that emotional pain for a solid three months after Judah's arrival. I would have dizzy spells and severe pain in my incision site off and on for 8 weeks. I could barely get out of bed by myself. I had nightmares.

One night, when Judah was two months old, I dreamed that I took a piece of glass and sliced open my own belly. I woke up completely terrified-- more afraid than I had ever felt in my life. I remember lying there in bed awake, but feeling unable to move or speak. I felt such an intense heaviness. I know that this was a demonic attack. After a few minutes of silently praying to myself, I was finally able to speak and I called out to Isaac. It was about 3am. He woke up, sensitive to the trembling in my voice, and knew that something was deeply wrong. I just said "pray for me!" and all of a sudden my husband started praying in tongues over me. I had never before heard him pray in tongues. Instead of being afraid or uncomfortable with it, it was the most beautiful sound I had ever heard. It gave me such peace and comfort. I just started weeping. I told Isaac about the dream and the incredible fear that had crippled me and he stayed up with me the rest of the night, praying over me. I finally had freedom from the nightmares after that night.

Another time, a few weeks later, I remember getting frustrated with my appearance when I was getting dressed in the morning. None of my clothes fit right and almost everything I owned had spit-up stains on it. I was a mess. I became so upset that I literally threw myself on the bathroom floor, started screaming, and banging the floor with my fists. Isaac just stared at me, unsure of what to do. I couldn't stop. I had no control over myself.

I know that what I experienced was way more than just "baby blues". I was never diagnosed with postpartum depression... but there was definitely something wrong with me for those first three months. I praise the Lord that he rescued me from that incredible depth, that darkness. It was so difficult.

Even now, I'm occasionally overcome with weeping when I reflect on Judah's birth. It was so difficult to completely lose control... To have my baby surgically cut from my body, when I was so close to delivering him on my own. To irrationally feel like a failure as a mother, a wife... as a woman.

I never want to experience that again.

So anyway... here we are, 28 weeks pregnant with baby girl. I finally met with an actual doctor at my OB practice (I had only seen nurse practitioners up until now) and she seemed almost annoyed when I even mentioned wanting to VBAC (have a vaginal birth after a cesarean). I felt like she was pushing me to just schedule a C/S (even though I know from nursing and medical journals that VBACs are considered safer than elective c-sections). She mentioned a bunch of scary statistics ("your risk of uterine rupture is 6%!" which is not true-- everywhere I've read in the medical literature, my risk of uterine rupture if I attempt VBAC is less than 1%. So I don't know where she got that info!) and said "well, your son was 2 lbs larger than an average baby which is hard for anyone to deliver... you'll have greater peace of mind and it will be less traumatizing if we just schedule a C-Section. But, if you want, we'll wait to officially schedule you until we scan you at 37 weeks and see how big this baby is... then we'll schedule your surgery for May 28th."

How does she know what will be less traumatizing? Every time I read about a successful VBAC, the woman exclaims that she felt so empowered and found emotional healing. I want that! I don't want another major surgery that will leave me unable to hold my two children for weeks. How can I take care of two kids by myself (Isaac can't take much time off of work... a couple days at most) if I can barely get out of bed? Even my friend that wound up with a second emergency C/S after trying to VBAC said that she has no regrets that she at least tried. Also, we're thinking of having more than two children. Once a woman has two or more C-Sections, it is much more difficult (almost impossible in this area) to find a doctor willing to let you have a trial of labor.

So... since I am not going to find true support through my current OB group, I decided to switch to the Nurse Midwifery Associates. I saw them for the first half of my pregnancy with Judah and just loved them. As a student, I attended many of their deliveries. I know that they will give me the flexibility, the patience, and the support that I need to have the best possible chance of a happy delivery! :)

And I know that whatever happens, God will never leave me or forsake me. He goes before me and beside me. He knows my pain and my hurt. And he is faithful to turn our mourning into gladness. I have the most amazing 19 month old boy. I love him with everything in me, more than I knew was physically possible. I am so blessed. And, yes, he was worth it all. Praise Jesus!

comparison

A conversation with a friend last night led me to consider my first minutes of motherhood: My son was born through an incision in my abdomen. I didn't hear any crying (there was meconium in his amni otic fluid, so he was immediately taken to the radiant warmer and the neonatologist intubated and suctioned his throat). Instead of crying, I heard gasps: "WOW, what a BIG baby!" "Sigrid- you birthed a toddler!" The room was bright and sterile. I felt like I couldn't breathe because the anesthesiologist was too busy playing on his iPhone to realize that the oxygen mask was clamped too tightly and pinched my nose shut. My arms were shaking violently and I was hyperventilating. I couldn't see a thing- the blue surgical curtain was blocking my view of my baby. I felt very distant and removed. Finally, after what seemed to be an eternity- I heard a loud lusty cry from my son. A nurse showed me a card with his footprint on it- the first visual proof of my baby. My husband asked if I wanted to see a picture of him on the camera. No. I was too broken in that moment- too upset. It was nearly two hours after his birth that I finally got to hold him. I was the 9th person to do so. I am quiet and subdued.

the first time I get to see Judah! on the OR table getting put back together.

In recovery... unable to move or feel my legs. Can't sit up... arms are still shaking and I am physically unable to hold my newborn son.

I'm a mess.

22 months later:
Lilee is born after a completely spontaneous and natural labor. The room is dim, quiet, and relaxing. My midwife catches her and immediately places her on my belly. The feel of her wet skin is something I will never forget. She is crying loudly and is soft and pink. I am overwhelmed with joy and start proclaiming my love for everyone in the room. My baby never leaves my arms. I just cradle and kiss her over and over as Daddy gets to cut the cord. I am the first person to hold her. I am so alive and in the moment, proud of our achievement. I start talking a mile a minute- I'm just so excited. Everything is right in the world and life is beautiful. I am amazed at the beauty of God's design.

seconds after birth!

Daddy cuts the cord as I hold my baby.

My awesome midwife. I feel great!

Someone once told me "it doesn't so much matter what kind of birth you have-- the babe's the thing!" And, yes, I totally agree with that last part. If I get too caught up in the birth story, I miss out on the point-- the Babe Is The Thing! However... the birth does matter. It matters a lot. For me, my cesarean led to months of physical and emotional pain. Feeling robbed and violated. My VBAC led to feeling reborn and victorious. I praise God for both experiences and know that both are integral parts to my story. I just get so angry, though, when the medical community forgets how much birth does matter to a woman and just pushes her through the system and she gets lost in the shuffle. I see it every day at work. It makes me so sad.

Birth trauma is a real thing and needs to be acknowledged. My dream is for surgical birth rates to plummet and for more and more women to come out feeling victorious and powerful. We are the crown of creation. We were designed to be strong and powerful. God's way is always best. My prayer is that the medical establishment can respect that and stop living in fear of law suits and start honoring women and their ability to birth. Until then... I will purpose to listen to my patients' stories, help shoulder their burdens, and share in their joy. I will encourage and lift up and offer hope. Birth is beautiful. And the babies we birth are beautiful. And it all matters.