It was a cold night in October …” I can now joke about that night with my husband and my best friend from OB/GYN residency. I had worked a Saturday 24-hour call shift, and as soon as I got home on Sunday morning, I began having symptoms that made me turn around and head right back to the labor and delivery unit where I worked … as a patient. It was my first pregnancy, and I had nearly made it to the third trimester without any major problems until that morning. I soon found myself being diagnosed with preterm labor and a suspected placental abruption, a situation in which the placenta begins to separate from the uterus, which causes pain, bleeding, and a potentially serious situation for the mother and baby. I received several medications that I had often ordered for my antepartum patients — steroids, magnesium, antibiotics — never thinking I would ever have to receive them myself. On our labor and delivery board, we listed our active laborers in green marker, our triage patients in blue marker, and our antepartum patients in black marker. The antepartum patients were the ones who were admitted remotely from delivery (or so we hoped) in the 20-something or early 30-something week range. I never imagined a pregnancy scenario that would involve my name on that board in black marker. But there I was: “Daum G1 27w6d” (code for “Daum, first pregnancy, 27 weeks and six days”). My best friend Jill was the chief of OB nights when I got admitted. She was going to start her string of Sunday-Thursday shifts that night, and when she heard I got admitted that morning, she showed up within a couple of hours with a bag of supplies — magazines, snacks, lotion, chapstick, comfy socks, dry shampoo — everything she could quickly think of to help me occupy and take care of myself during this uncertain period of time I would spend “in the slammer” (that’s what I started calling the antepartum unit after knowing what it feels like). Many patients spend several weeks in the antepartum unit. It’s a hot mess of mixed feelings — you are so bored, trapped in the same four walls for an indefinite amount of time — but you also want to stay pregnant for as many more weeks as you can. I made it a total of four days. By that Thursday morning at 28w3d, I was begging to go home. My symptoms from Sunday had nearly resolved. “Can’t I just get my daily NST [non-stress test] during my shift tomorrow?” “I promise I will monitor my symptoms and come back if they get bad again!” “I spend half my time here anyway; what difference would a discharge order make? Just let me go!” Thank goodness they didn’t. While attempting to spare you the specific, slightly gruesome details, let’s just say that I experienced a sudden, severe increase in the symptoms that originally brought me in. My placental abruption, considered “chronic” after a few days of stability, became “acute” in a matter of minutes. It was time for delivery … at 28 weeks and three days. I was taken for an urgent cesarean section, and our sweet Carter Joseph was born that night. As they yelled, “It’s a boy!” and my husband and I heard him cry, all we could do was also cry because we were so scared for him. It was October; my due date was in January. How could this be OK? But it was OK. My favorite attending physician and my best friend from residency saved my baby’s life. And quite possibly mine, as well. It never remotely crossed my mind to question, regret, or feel sad about the mode of delivery being a C-section. I was having an obstetric emergency, and I needed a C-section to get my baby and myself through delivery in the safest way possible. It is what it is. Two people who cared very much about me, through personal and patient/doctor relationships, decided to proceed with a C-section because it was the safest thing to do. It is scary to think about what would have happened if that same pregnancy occurred before the era of modern medicine. We are too hard on ourselves. “I had a C-section because my body couldn’t do it.” Well, it probably could have, but at what expense? Pregnancy and delivery are not benign processes. By some estimates, up to 1 to 1.5 percent of births resulted in maternal death in the 1700s to 1800s. The main causes of death were infection, hemorrhage, and seizures. What could have happened without the C-section if your C-section was due to fetal heart tone issues? If your C-section was due to dysfunctional labor or the baby not fitting through the pelvis, what could have been the alternative 200 years ago? That delivery could have happened at the expense of the baby or the pelvis; it is eye-opening in an awful way to research the history of how these deliveries were previously managed. The most common reasons for C-sections are labor dystocia, fetal heart rate abnormalities, fetal malpresentation, and multiple gestations. Labor dystocia refers to slow or obstructed labor; the patient who dilates to six centimeters and does not progress past that point, the patient who pushes for hours without any fetal descent, the patient whose water broke yesterday who cannot kick into active labor. Fetal malpresentation refers to a baby who is not presenting head-first. Multiple gestations refer to twins, triplets, etc. Although these are the most common reasons for C-sections, there are always exceptions to these trends. Plenty of patients have had twins vaginally, even with the second twin presenting breech. Plenty of seemingly slow labors end up with successful vaginal deliveries. There are moments of temporary fetal heart rate abnormalities that improve within a few minutes. Don’t get me wrong, safe vaginal delivery is my goal for every patient, if possible, as long as the benefits outweigh the risks. There are plenty of reasons to avoid C-sections if we can. A C-section involves increased risks of pain, bleeding, infection, and other risks we would generally like to avoid for patients. However, a delicate balance of risk/benefit comes into play since two patients are involved, mother and baby. I believe in a thorough consideration of options, keeping my patients involved in my thought process regarding their particular situation, and informed consent. My job is to use my medical knowledge and training to help navigate my patients through Mother Nature’s obstacles. Another point to be made is that just because one delivery results in C-section doesn’t mean the next one has to. I am supportive of VBAC, or vaginal birth after cesarean: I have had three VBACs myself. Just because you have a C-section this time does not necessarily mean you have to in the future; this is worth a discussion with your doctor if you are interested in this option. My point of this post is for C-section mothers to give themselves some grace. This is not a failure. A C-section is not a defeat. It is another way to have a healthy baby. It is not a failure on the mother’s part. It turns out that the cold night in October, the night I had my C-section, brought my family the best gift we had ever received. We made it through that night with a healthy baby and a healthy mom. My C-section was not a defeat. It was the only way to safely get my son and myself to the finish line. So show some love to the C-section moms in your life: Check on them, support them, encourage them, and try to go easy on the “dad jokes” in the days following delivery … laughing hurts for a little while. Source
