Choosing birth types

To “C” or Not to “C”? Cesarean Section-That was the Question.

January 22nd, 2010

I’m not sure if I am the person to write about whether or not to have a cesarean section delivery given that I have had 2IMG_3750 1x13 c-sections myself. My history of Uterine Fibroids, surgery to remove them as well as repeat miscarriages made both of my “successful” pregnancies high risk. According to the surgeon who removed my fibroids, he had to do several cuts to remove the tumors and vaginal birth posed too great a risk of uterine rupture in my case.

I had a lengthy discussion with my OB during my first (successful after miscarriage and surgery) pregnancy to see if there was any chance that I may be able to deliver vaginally. Her response was, “Well, we could try but I would only allow it if you delivered in a surgical suite with an epidural so that if I had to do an emergency c-section, we would not lose any time. While I was mulling over her words over my husband piped up with, “Are you out of your mind? After everything we’ve gone through to finally have a baby, you want to risk your health and the health of our baby just to say that you pushed her out? No!” So we scheduled the c-section.

Looking back often wonder if I shouldn’t have pressed further. In the end my daughter’s birth was somewhat of a night mare. I went into labor 3 weeks early and technically because I was at 36 weeks and 6 days, I was in “preterm labor”. The doctor on call for my OB (who was out of town) tried to halt things, but in the end my daughter was coming-I was dilating at least 2 cm an hour and so we took her out. I have often wondered if with such rapid contractions and dilation and since I wasn’t in a lot of discomfort, what would it have hurt to let her come out naturally? My daughter was born 5 lbs 3 oz, and was only 18 inches long. I really think I could have gotten her out with minimal trauma to either of us.

When my daughter was taken out of me, my husband says she was gray and floppy and they had to work on her before she cried. She had fluid in her lungs. Had she been vaginally delivered, her passage through the birth canal would have squeezed much of that fluid out of her lungs naturally. Instead she spent 10 days in the NICU and had moderate to severe asthma as a toddler. Was this due to the fact that she was “preemie”, had had fluid  in her lungs at birth or the fact that there is significant asthma in both my husband’s and my families? There really is no way to tell, and I will probably always wonder if I made the best decision for her. But it really doesn’t matter because I am happy to say that now, at 7 years old and quite the diva, my daughter has not had an asthma attack in 2 years and seems to have no other residual signs of prematurity.

For me, the birth was equally traumatic. Everyone was rushing around frantically, clanging instruments and setting everything up. The epidural immediately made me sick and I threw up throughout my delivery which made the OB’s job harder because my abdominal muscles kept moving while she was trying to do the c-section. Once my baby was delivered, I bled profusely. With each stitch placed I bled and the doctor finally had to inject pitpressin (a combo of pitocin and vasopressin) around where she needed to work so that my uterus would clamp down and help stop the bleeding. I realize that this was more controlled bleeding, not a blow out like uterine rupture would have been, but was it really better? I was traumatized and sick as a dog. My baby had been whisked away and my husband was frantically trying to attend to both of us. Yeah, everything worked out but I will always wonder if a vaginally delivery could have been smoother.

When I was having my son 3 1/2 years later, a much calmer and uncomplicated pregnancy, I wasn’t even offered the option of a VBAC. I had had yet another miscarriage between the two pregnancies and was now 40 years old. Everyone kept telling me that I was lucky to be where I was and to “not tempt fate.” I suppose that I shouldn’t have even contemplated vaginal delivery, but my son went to term (or would have if we had left him alone instead of taking him out at 39 weeks. I hadn’t dilated at all and he was content as could be inside!) and was delivered without complication (except the first epidural was misplaced and only numbed my left leg/side. They redid another which worked but left me with back pain for about 4 months after the delivery). I didn’t bleed after his delivery like I did after having my daughter and although my uterus was “boggy” to quote my OB (who was in town this time and delivered my boy),  the placenta was removed and I was closed without problems.

My children are 7 and nearly 4 and I am quite finished with “baby making”. But often I just wonder….did I do the best thing for my daughter? Should I have fought harder to allow my son to come when he was ready and to vaginally deliver ? Hindsight is always 20/20 and I believe that if my OB had been present with my daughter, I would have been able to give vaginal delivery a try. Likewise, had I even been offered a VBAC, I would have tried it with my son, especially since my OB was present at the delivery.

For me, the question of vaginal delivery versus c-section is moot. For other women mulling over their options, I suggest you get as much information as you can not only about vaginal deliveries and cesarean deliveries, but also about your particular situation. Ask your clinician what he or she thinks is the likely scenario in your case? Do they suspect that you would have a hard time delivering your child? Do they suspect bleeding as was the case with me? Are there other complications they are considering that are influencing their recommendation for you? Learning these facts helps you make an informed decision about your delivery and the birth of your child. Don’t settle for, “I just think a cesarean section is best in your situation.” Ask why they they think it’s best, get the specifics. If the cesarean recommendation is not based on clinical evidence or suspicion of a complication stop and consider all your (other?) options. Work with your clinician to plan for the birth of your child and be clear (as you can be) on what is  “expected” for your delivery and what will happen in the event of an emergency. I had no such plan (didn’t know I had that option) and I got what I got. I have no regrets but with more information I certainly would have done things differently.

Did you have a cesarean section? How did you make the choice? Please share your story in our comments sections.