Friday, May 19, 2006

Cesarean Birth

This couple has had their share of difficulties in birth.

The first birth ended in a cesarean after many, many hours of labor. While mom was disappointed, she was happy she had a healthy baby girl.

Pregnant the second time, she didn’t even consider a VBAC, but scheduled a cesarean so she might have some control over the situation… not being so exhausted and having it happen so fast. During the cesarean, she was thinking, “this isn’t so bad… I could do this again,” and her baby was born and he cried, but then things began going terribly wrong. The baby, in the warmer, wasn’t being brought to her… a nurse kept coming back saying, “He’s doing okay,” and after the second time, she knew something wasn’t right. Hoards of people came and surrounded her son before a nurse came and said he needed to be taken into NICU right now. All she saw of her son for 48 hours was a white hat leaving the room she couldn’t move from.

Her son had serious cardiac issues that required surgery to repair (several surgeries) and he was quickly airlifted to the nearest large children’s hospital hundreds of miles away. Mom checked herself out of the hospital 48 hours postpartum and drove to the baby where she didn’t leave for 4 months.

Sitting in the NICU next to her baby, she realized she hadn’t gotten a prescription for any pain meds, but a nurse took pity on her and fed her Vicodin to quell the intense physical pain.

Nothing could quiet her emotional pain.

Eventually her son got well and came home, needing to be watched a lot, but doing very well considering everything. Mom pumped for a long time, extending past the NICU time, but never was able to nurse her son.

She waited 5 years to consider pregnancy again. During that time, she became a serious VBAC proponent and knew she wanted a VBA2C. She came to me wanting to have a home birth, but her husband, understandably traumatized from the last birth, really felt it wouldn’t be the best idea and wanted her to have a VBAC in the hospital. After a lot of discussions, she decided to change to a physician that would support her desire for a VBAC (one I have had success with before). Resigned to the hospital birth, we began planning her VBAC (I was to be her doula).

Earlier in the pregnancy, an issue arose with the baby’s kidneys. Now, it isn’t unusual at all to have dark spots seen on ultrasound early in the pregnancy when looking at the kidneys. The fetus usually outgrows it, but her baby had not.

Sent to a neonatologist, he was a complete asshole to her. This mom probably knows more than many NICU nurses about medical complications in babies and this doctor talked to her as if she was the village idiot. She explained her knowledge of the kidney issue and he was insulted she would know what she did… that he wasn’t the one to tell her any information. He skimmed over talking about the kidneys and had to be reminded more than once to focus on them and not her pregnancy and how she HAD to schedule a cesarean for her child’s safety.

During a late ultrasound, the baby was oblique and the umbilical cord was dangling at the mouth of the cervix. She began seeing that a cesarean might be likely and we quickly began choreographing a cesarean that offered the most control over the situation. She emailed me her birth plan which included NO HATS. I gently explained that the baby had to have a hat and to choose a hat that she could live with. She understood and set out to buy several choices.

As with my other mama who wasn’t sure when she would believe the baby was here to stay, this mom said crying wasn’t going to cut it to let her know he was fine… she wasn’t sure when that would happen, perhaps when he nursed.

Another ultrasound showed the baby breech and mom, at 36 weeks, was ready to have the baby… the cord was still down under the baby’s bottom. Her doctor said she’d schedule her for a cesarean no sooner than 39 weeks and my mom had a fit (rightly so). What is so funny/odd about this is in a typical situation, we would LOVE a doctor who wouldn’t schedule an early cesarean, but in this case, mom had good reason to fear her baby’s safety and she insisted, with my support, on having a cesarean sooner. The doctor said she would only do it if she had an amnio first to see if the baby’s lungs were mature (mom was 37 weeks at this time), so she went in yesterday for an amniocentesis. After explaining that an amnio is easier/safer later in pregnancy because finding a pocket that isn’t near a fetal part is easier, mom was reassured.

When we talked about it, I off-handedly said, “What’s the worst that could happen? Your water could break and you would have a baby.”

I got a frantic call from dad that said, “Her water broke! She wants you now.” I said, “I’m on my way,” and flew out the door, getting to her in 20 minutes (a usual 45 minute trip!).

The sono during the amnio showed the cord still below the baby and the baby was oblique; a dangerous situation for sure. The amnio went well and mom was resting, semi-reclined, in bed with the monitors on and 10 minutes after the procedure, her water broke with a giant gush.

Things went into fast forward as a cesarean was going to happen sooner than later. When I got there, I saw she was having some decent contractions and she said she’d woken up with contractions and let them come and go, feeling them knowing the baby was choosing his own birthday. She glowed!

She was so, so thankful she was in the hospital and lying down when her water broke. Her greatest fear was a prolapsed cord and we discussed, several times, what to do if her water broke and she was alone. (She initiated the repeat discussions… I initiated the first one.)

A short segue:

This mom and her family are Disney freaks as much as my family is. Equal in every way. They brought their 5-year old son to a prenatal one time and he and I discussed Disney World as if we had visited together and gone on the same rides thirty-five times. That child knew the details I did and his mom and dad joined in as we discussed our favorite things; many, many in common. This family goes to Disneyland and Disney World as much as we do… a surprise connection we both reveled in. When I got to the hospital, she had not planned to have a baby that day, so didn’t have the cd she wanted to birth to… Reflections of Earth from IllumiNations at EPCOT. It is hard to explain, but this music is so powerful and we have seen IllumiNations so often, we can “see” the entire show just by listening to the music.I know this sounds so crazy to many of you reading, but when I went to Disney World recently and couldn’t get there until 9:00pm (when EPCOT closes), I used up a ticket to get into the park to see IllumiNations… standing there sobbing listening to the music and basking in the beauty of seeing the show live. Reflections of Earth is so powerful, punctuated by lasers, cannons of fireworks, glittery fireworks and a three-dimensional globe in the center of the lagoon that displays everything from a baby’s crawling to a montage of walking feet around the world… so hard to describe the utter beauty of this show.

Mom was very upset she didn’t have the cd, but I thought, “OH MY GOD! I have this on my iPod!” and told her and she was ecstatic! Laughing, she said, “The only other person who would have Reflections of Earth in her possession!” I pulled out my earphones ($200 ones that block out everything else) and turned on Reflections of Earth for her once she was ready and she closed her eyes and went to EPCOT for a few minutes. I was so, so happy I could do something to make her experience happier. She visibly relaxed and when she was wheeled into the OR, she was smiling.

While we waited for her to get the spinal, her husband dressed and then sheepishly looked at me and asked, “May I listen to Reflections, too?" Smiling, I pulled out the headphones again and played the music for him as he sat, eyes closed, also transported to EPCOT. He thanked me so much for having it and when he went into the OR, he, too, was smiling.

She’d asked me to listen to it during the surgery (they wouldn’t let her take the iPod into surgery), so I sat in the room listening for her.

Her beautiful 8 pound son was born during a crescendo of fireworks and shortly after, he came back into the room with dad. Mom followed after 20 more minutes, both “recovering” in the LDR room she’d started out in. Very different from many hospitals that separate mom and baby during recovery. Very nice!

Her son wanted to nurse when he arrived and was delighted to be held to latch onto mama’s nipple within moments of her return. He nursed for 40 minutes. I held her son and helped her with her breast (after asking, of course) so she could remain flat and still nurse him. She saw that he was wonderfully alive and well and would not be taken from her as her other son had.

She will see a pediatric nephrologists soon, but he looked so wonderful, the pediatrician didn’t think it would be a serious issue, at least at this time. Good news, for sure.

Three babies in four days. 1500 miles in a week. I am pooped! But gloriously happy.

All mamas and babies are well and happy.

What more could a midwife ask for?

1 comment:

Anne said...

My daughter was born to "Reflections of Earth" too! And "Tapestry of Nations" during transition. It was glorious, as only a true Disney freak could understand.