From One Caesarean to Another

By Caroline McCullough

A woman in labour is rushed to the hospital. She can feel the contractions but something is not quite right. The obstetrician greets her in the labour suite. “Let’s have a listen and see what’s happening”. He places the cold stethoscope on the woman’s belly and listens, his smile quickly turning to a frown.

“I think we need to see what’s going on in there. We’ll get this baby out…don’t you worry,” he says patting the labouring woman on the back. “These breech babies can be unpredictable.”

Moments later the woman is wheeled into a room and a picture is taken of her belly. From behind the curtain she can see the obstetrician and midwife leaning over a darkened film.

The midwife grabs a piece of paper and runs towards the phone. The obstetrician comes over to his now very frightened labouring woman. “We have to take this baby out by Caesarean section. If we don’t, it will die.”

Two hours later, the woman is put under General Anaesthetic and the operation begins.

Six hours later the woman wakes up in recovery and is wheeled into the maternity ward where there are another seven mothers recovering from their vaginal births. She sleeps through the night after being told it is best not to breastfeed her tiny baby which is now in NICU. “Oh, by the way, it’s a girl” the midwife tells her before she walks out. Her baby is brought in the following morning. She smiles and looks upon her new daughter…she thinks to herself “with that lovely head of dark hair and her round face she is so pretty compared to these others with their misshaped heads that were squeezed through the birth canal.”

This is the story of my birth and for 32 years I have lived with the knowledge that I was special, that God put me on this earth for a reason or else I would be dead, but sadly also that I put my mother through hell and was considered to be the most difficult child in my family. For many years I could not bond with my mother, could not endure her touch, could not relate to her-that is of course until I had my own Caesarean experience.

To be truthful, in part I blamed my mother for my failure to give birth vaginally. I felt guilty when my mother made a point of reminding me of how sick I made her, how she had to endure hormone injections during her whole first trimester in order to prevent a miscarriage, how she had to be cut open with the help of six nuns and four doctors in order to save me from certain death-a pathetic, little baby who came into this world, the life nearly squeezed out of her by a tangled cord, but still holding on.

When I spent every single day of my first pregnancy hanging over some toilet or other, I could not get the echo of my mother’s words out of my head. Was it guilt? Or maybe fear? I guess I will never know. And still the affects of my mother’s horrible pregnancy lingered as I endured multiple vaginal examinations to determine if DES exposure (DES was a drug used prior to 1971 to prevent miscarriage in women who were haemorrhaging first trimester. This drug caused incompetent cervix in women born from these pregnancies) was going to cause my cervix to prematurely dilate.

I would have blamed her for the C-Section itself except for the fact that there was one fundamental difference between my birth and my son’s birth-that being the operation that saved my life was necessary and there was no prior intervention just a simple truth that without the caesarean my life would have ended before it began.

My son’s Caesarean birth was precipitated by a failed induction at 39 weeks gestation for pre-eclampsia when the baby was not fully engaged and the cervix was rock hard. My obstetrician had basically used my high blood pressure as an excuse to “put me out of my misery” even though there was some doubt as to whether I really did have pre-eclampsia (my BP was 145/95). When my incoordinate and overlapping contractions started to take their toll on my will and confidence, I asked for a Panadol and was given a cocktail of drugs including an epidural which had me flat on my back.

Predictably there was fresh meconium in my baby’s amniotic fluid accompanied by a massive drop in the foetal heart rate, so within 20 minutes I was wheeled into theatre for an emergency C-Section. This C-Section turned out to be the C-Section from hell. I still relive the nightmare of feeling the physician’s forceps inside my pelvis as she pulled the baby’s head out of my body. I remember telling the anaesthetist that I was feeling pain and getting more and more frightened that it was going to get a lot worse. After all, nobody told me any different and my concerns were basically ignored until I started screaming at the operating team. I didn’t want to be separated from my baby and was crying out for him when they whisked him over to the suction table. An hour later I woke up in recovery and found out they had put me under General Anaesthetic half way through the operation, most probably to shut me up. Why didn’t they just hand my baby to me? I would have shut up then.

Now as I prepare for the birth of my second child I have abandoned the expectations of my family to put the management and outcome of my baby’s birth into the hands of an obstetrician and have taken matters into my own hands. I still have a doctor (one who is very supportive of vaginal birth after caesarean or VBAC) but I also have hired a professional birth support person as I felt that I needed that extra support during labour from someone I had gotten to know and like.

Despite my efforts to remain positive and keep my expectations high, my mother takes great pleasure in telling me that in her day, they “didn’t expect birth to be a wonderful experience,” they just did what they were told. The problem is, that obstetricians in the late 60s and early 70s still had some respect for natural vaginal birth that sadly seems to be missing in our modern world of intervention and management. The Caesarean Section rate in the 1970s was around 10 to 15 percent and obstetricians still had the skills to deliver breech babies, perform external versions and assist with the vaginal delivery of twins no matter what their presentation. Yes, they made mistakes back then but overall women knew they could birth their babies naturally and even if they had C-Sections they still birthed subsequent babies vaginally without questioning their ability or choice to birth the way nature intended.

Nowadays, unnecessary intervention and clinical management of labour have caused the Australian Caesarean rate to soar to around 25 to 30 per cent (and even higher in some private hospitals). My story is not unique. I hear of so many women who have been induced early only to find that they have been left nursing a scar the next day. It seems that nearly every birthing woman is administered Syntocin to keep labour going no matter how well she is progressing, and when she does not progress at the standard one centimetre per hour or with less than two hours of pushing, the woman is often told she has a problem or she is the problem, that she can’t birth vaginally, that there is something wrong with her. Never mind the drugs that have been pumped into her, the lack of much needed continuous support and encouragement to help her deal with her fears, the birthing positions which restrict her mobility and her pelvis’s ability to open wide enough for the baby to pass through, the instructions to push before she feels the urge, the monitor strapped to her belly and the IV drip surging through her veins.

No wonder women who have endured labours under these conditions have ended up having Caesareans and no wonder they believe that they cannot birth vaginally, and no wonder they don’t want to put themselves or their babies through a vaginal birth ever again.

Vaginal birth has been labelled as “dangerous”, and damaging to the baby and C-Sections have been normalised and glorified as the great operations that “save babies lives” when all else has failed. It is disconcerting that obstetricians use mortality statistics as the basis with which to argue the case for elective Caesarean births, whether it be deemed necessary or not . In doing so, they not only disregard the compelling medical evidence that shows, in the absence of major complications, the advantages of a vaginal birth for the health and safety of mother and baby but choose to ignore it altogether. What about the effects of Caesarean birth on the mother’s hormones, the bonding between mother and baby, breastfeeding, the baby’s respiratory system and liver function, and the mother’s postnatal recovery and maybe even her fertility? Just because fewer babies die in childbirth in this country compared to the majority of others does not mean that Caesareans produce better outcomes than vaginal births. According to World Health Organisation  data on maternal and perinatal mortality, in the Netherlands, where the Caesarean rate is currently about 12 per cent , outcomes are equally as good.

Mortality statistics do not take into account the psychological impact of birth on the mother and baby. Too many women describe their childbirth experiences as painful, horrific, terrifying and disempowering. Too many women talk about being abandoned by their “carers” during their labours or having pressure put on them to accept intervention. Too many women talk about having no choice but to do what someone else wanted them to do, whether it made sense or not. If this is the case, there has to be something deeply wrong with our medical birthing model that mortality statistics can never show.

One study conducted at the Women’s and Children’s Hospital in Adelaide, South Australia in 1996  assessed women’s feelings about their Caesareans seven weeks after their babies were born and only 8.7 percent indicated they were unhappy with or unsure about the decision to have a Caesarean. Interestingly, about 18.9 percent indicated they felt the operation may have been unnecessary. I have to wonder if the same sample of women were asked how they felt about their Caesareans a year down the line, or when they were once again pregnant, how much the responses would differ. My guess is they would differ significantly. I did not question the necessity of my son’s Caesarean birth or what chain of events lead to it until months later when I found myself floundering to cope with even day to day tasks, dealing with panic attacks and flashbacks of my operation. I did not examine the effects of my son’s caesarean birth in any great detail until I was pregnant again (2 ½ years later) and found that my previous Caesarean would put me in the high risk category for any subsequent pregnancies.

When my mother became pregnant with my younger brother she was expected to birth vaginally and naturally. A Caesarean Section was still considered to be a drastic last resort. And so, my mother birthed a nine pound baby boy and didn’t think anything of it (even though she had been told by one doctor she could never vaginally birth a baby bigger than 7 pounds).

Nowadays when a woman “chooses” to VBAC, she endures threats of uterine rupture, of hysterectomy, a dead baby, monitoring and IV lines “just in case”, hyper vigilant obstetricians who “won’t let the woman” labour too long “just in case”, and hospital personnel who jump every time a monitor registers a slightly unusual blip in the baby’s heartbeat. Amongst this kind of nervousness and fear it is no wonder a woman shies away from VBAC and towards the seemingly inevitable repeat Caesarean.

Yes my Caesarean birth was a necessity, but it is highly likely that my son’s would not have been had his birth not been so tampered with. And even though I have been an adequate and loving mother to my son, my struggle to treat him as my own in the days following his birth will haunt me for the rest of my life. I will never know for sure if the epidural I had been administered caused him to go into distress, thus making his Caesarean birth a necessity. I may never know if his inconsolable fear in the night and innate sensitivity is due to something I did or did not do while trying to cope with the fallout from my traumatic birth experience. I cannot truly say that without any prior intervention his Caesarean birth would have been necessary. My mother never had to wonder if she had been failed by the medical birthing machine but I do everyday.

Caroline (Cas) McCullough has a Master of Business from QUT and after
working in public relations and marketing for several years she had a
career change last year and is now a singer/songwriter as well as a
mother to Liam (3) and Daniel (3mos) and wife to a wonderful husband
Wayne. Cas is a member of the Birthtalk support group in Brisbane and an
avid birth care reform campaigner.