November 25, 2009, I gave birth to my son Octavian Orion. This is our birth story.
Part I: Pregnancy
Somewhere around my 26th week of pregnancy, our midwife Heike taught us how to find the baby’s head in my belly. “It’s called ballottement,” she explained, showing us how to press on the lump in my belly to see if it bounced like a little tennis ball.
“That’s his head,” she told us. “See how it bounces around? That’s because of his neck. If that was his butt, it wouldn’t bounce.”
His head was just under the right side of my ribcage, meaning he was breech. “Don’t worry about it,” my midwife said. “Most babies are breech in the second trimester. He’ll flip.”
I started doing exercises to encourage the baby to flip. I found a website full of ideas, mostly inversions that involved elevating my hips to encourage the baby to shift out of the pelvis and somersault into heads-down position.
He didn’t flip.
I started trying other methods. Our neighbor was an acupuncturist, and he gifted me two treatments a week of both acupuncture and a technique called Moxabustion. Twice a week he’d come over and poke me with tiny needles and then burn mugwort incense by my toes to energize the baby in the hopes of making him turn over.
He didn’t flip.
I started trying every technique that people suggested. Ice packs on the baby’s head. Having Andreas talk to my pubic bone in the hopes that the baby would flip to hear him better. Using a little flashlight to try to lure the baby downward. Massaging my own belly. Visualizing him flipping.
He didn’t flip.
As I approached week 30 and onward, I started to get worried. If he didn’t flip, I wouldn’t be able to have my birth at the birth center. I wouldn’t be able to have a vaginal birth at all. Neither midwives nor doctors in Washington State do breech vaginal deliveries. I started freaking out. I would wake up in the middle of the night and put my hand on my belly – was he still heads up? Was he? Was that maybe his butt and not his head? It was never his butt. It was always his head.
He didn’t flip.
I found myself one afternoon doing a breech inversion on the stairs of our home, tears winding their way up my forehead because I was hanging at an almost-upside down angle thinking to myself “Flip, baby, flip.” I was frustrated and sad and suddenly realized … I had to let it go. I couldn’t make this baby flip.
At week 35, I started exploring my options. I called the office of my longtime OBGYN, who I’ve always liked a lot. Would they see me if the baby wouldn’t flip? They would.
My midwife suggested one last method: External Cephalic Version. The medical procedure involved going into a hospital at 37 weeks, having a uterine relaxant given via IV, and then a doctor trying to physically manipulate the baby into place via what can only be described as “extremely deep massage.”
We tried it, a couple days after my baby shower. The doctor gave it an extremely good shot, literally working up a sweat as he spent 20 minutes shoving and pushing on my belly as I breathed my way through it.
And still, the baby did not flip.
It was time to move to Plan B: a scheduled Cesarean section. A surgical birth. Yes, the irony of the midwife’s daughter having a pre-planned c-section is a killer. After all, I was the kid who, at 8-years-old, made a card for a family friend’s baby shower that read “I hope you don’t have a sea section!”
But I’d done everything I could, and even my mom the retired midwife agreed: at this point it was time to schedule the surgery with my OBGYN. There was a telling moment when, during a dinner at my mom’s house, a friend of her’s said to my mom (a retired midwife and midwifery educator at Seattle Midwifery School) “Ooh, what if Ariel went into labor RIGHT NOW?! You could be on hand to deliver your grandchild!” My mother just shook her head and replied, “I wouldn’t touch a breech delivery. If Ariel went into labor right now, I’d drive her to the hospital.”
Part II: Preparing
Of course, growing up the midwife’s daughter, I knew more about c-sections as a child than most adult women do. I still did a ton of reading to prepare myself, especially which aspects of c-sections were the hardest for mothers to deal with. Highest on the list: arms being restrained during surgery, baby being taken away after birth, sense of failure or loss.
Andreas and I started preparing a birth plan. The baby should be in Dre’s arms as soon as possible. All non-essential procedures should be delayed for as long as possible. I’d like my arms not to be restrained. The baby is not to leave the room unless something is terribly wrong, and then Andreas should be with him at all times.
I also prepared myself emotionally. Once we’d settled on a birth plan, I outsourced the enforcement to Andreas. I made the decision that once in the operating room, my goal was a positive relaxed atmosphere – NOT a controlled environment. It was more important to me that I meet the baby in a good, clear state of mind than that everything go exactly my way. Even if the surgery wasn’t the birth I envisioned, and if Swedish hospital’s operating room wasn’t the environment I’d envisioned, I would at least do everything I could to have the emotional atmosphere I had envisioned.
My OBGYN was in Ethiopia doing medical aid work through most of November, so we were scheduled to meet with another doctor in her practice for the pre-surgical check-in. The doctor was not nearly as friendly as my doc, and generally dubious about all our touchy feely birth plan questions. We reassured ourselves that she would not be our doctor, and that we’d have my beloved OBGYN.
Then we scheduled our son’s birth day: November 25, 2009. We had the option of having him on December 1st, his actual due date. But since he was breech, I didn’t want to risk going into labor early and being at the whim of whoever was on call at the hospital. I wasn’t going to get my birth center vaginal birth, but I wanted my doctor, damn it!
Well, and also I was quite sick of being pregnant. Walking hurt. Getting out of bed hurt. Everything was uncomfortable and unpleasant and honestly? Opting out of the last week of pregnancy sounded really fucking awesome. If I was forced to have a surgical birth, I could at least enjoy some of the convenience that it offered.
And so November 25th was the day. We would check into the hospital at 2pm for a 4pm surgery. It was set.
Part III: Birth
We started the morning with a huge breakfast, since I was going to have to fast for 8 hours before the surgery and was worried about getting “hangry” (hungry+angry). I spent the rest of the morning working on a pregnancy scrapbook that I told myself I had to do before the baby came, or else it would never happen.
The birth team assembled at our house around 1:30 on the day of the birth. Despite losing my birth center plans, I’d decided to keep my same team: Andreas, of course. Our doula Dawn, who’s assisted several unmedicated births and done doula training, but who’s also a pediatric nurse who used to work in the NICU. And my mom, the former midwife and retired RN.
Swedish Hospital is less than a mile from our house, so it was a quick caravan down the street to check in at the Swedish hospital at 2pm. We joked around as we got lost on our way up to the 5th floor maternity ward, and eventually got checked in and waited. At my request, my mom French braided my hair before our assigned nurse came to bring us back to the prep/recovery room.
The 90 minutes of surgery prep were pretty low key. I changed into a hospital gown and ugly hospital-issued socks and sat on a reclined table. I introduced our nurse, who was relatively young, to our birth team, and my mother lied by omission about being a retired midwife, identifying herself only as a “retired RN” (true) and then going further and saying that she had been an OB nurse (not true).
“Oh!” our nurse said. “Where did you practice?”
“Kitsap County,” my mom hedged.
“So you were at Harrison Hospital then?” our nurse asked.
“Many years ago,” was my mom’s semi-lie non-answer.
Then the nurse asked me a bunch of standardized questions about my health and pregnancy, and then some interesting bigger picture questions (but still scripted) questions like “Do you feel supported in this pregnancy?” and “Do you feel like you have good coping skills?” As odd as the questions were, I appreciated that they were asked.
I had an IV inserted, and we talked to the nurse about our birth plans. She was relatively accommodating about some of our requests (delaying the eye goo for as long as possible, having Andreas holding the baby for as long as possible immediately after birth, etc.)
One of the odder moments of surgery prep was when it came time to shave off the top of my pubic hair. “Do you mind if I do this in front of them?” the nurse asked, gesturing to my husband, my mother, and my dear friend. I shrugged. It felt pretty low on the spectrum of pregnancy humiliations, and realistically this was the same team that would be witnessing my abdomen getting sliced open and my uterus being pulled out of my body to be stitched up – so what’s a little public pubic grooming?
Half an hour before the surgery, my beloved OBGYN came in for a consultation. She and I have a super friendly relationship, so it was great to see her. She showed me that she’d brought her pink surgical hair cover to match my hair (aww!) and told us about her medical aid trip to Ethiopia. I introduced her to the birth team – she knew my mom was a retired midwife, but didn’t blow our cover. I mentioned that I’d love to have my birth team with me in the operating room, and she told us (as we knew) that ultimately it was up to the anesthesiologist to decide who they’d let in, but that things were pretty restricted due to H1N1 flu concerns.
Fifteen minutes before the surgery was scheduled to begin, the anesthesiologist came in to consult with us. He was a German named Hans Horscha, which Andreas immediately approved of and was excited by – although he never did out himself as a German speaker. Dr. Hans quickly ran through the process he’d be doing with me – a spinal block, bla bla bla – and then I pitched him with my plea to allow everyone into the room. He was non-committal, but said he’d think about it – as long as everyone promised to stay out of the way. I emphasized that both Dawn and my mother were RNs who’d observed many c-sections and were comfortable and respectful of operating room protocols.
There was a brief moment when I realized I could have music in the OR – but realized we hadn’t brought a CD – only an iPod. But we had a boombox! Could we bring in the iPod boombox, if we wiped it down with alcohol? It felt like I was asking a lot, but Dr. Hans was pretty understanding and said it was ok.
With still no solid answer about who would be let into the OR, Andreas and my mother were given oompa loompa surgical suits to put on. I mused on the amount of trash a hospital must produce in any given day. The nurse warned us that while the baby would have a very round head (unlike the cone-heads of many vaginally delivered babies) he would likely exhibit the odd head shape that many breech babies have.
“Their little skulls sort of look like an aerodynamic bicycle helmet,” she explained. “It goes away of course, but I don’t want you to be surprised.” (She was right, too: Tavi has a skull shaped sort of like one of the aliens from Alien – it protrudes pretty dramatically over the back of his neck.)
A little after 4pm, it was time to go. I was instructed to waddle down the corner with Andreas and around the hall to the operating room, where I then sat on an operating table. The OR was larger than I was expecting and a bit cold. Dr. Hans gave me a local anesthetic shot on my back, and then did the spinal block. It was uncomfortable but I did my hypnobirthing breathing exercises and did just fine.
Then it was laying back on the table while the surgical team came in – accompanied by my mom. As the team assembled things, Dr. Hans tested the effects of the spinal block by holding a cold stethoscope to my chest and then my belly to see if I could sense the difference in temperature. Interestingly, at one point he decided that the block wasn’t going high enough up my torso, so he just tipped the table a bit to take advantage of gravity. All these high tech drugs and beeping machines, and ultimately it comes down to using gravity to get the drugs to flow where they’re needed. HA!
At this point, I was completely numb from mid-chest down. I could feel the nurses arranging me on the table – it felt like my legs were in a frog pose and I had a fleeting moment of modesty before not caring. I asked Andreas to turn on the music we’d brought (“Into The Deep Blue Bindu,” an ambient track co-written by our friend Rara) and I focused on my breathing to keep myself calm and focused amidst all the beeping and bright lights of the OR.
Then I heard Dawn’s voice as she walked into the room. “I don’t know how you did it, Ariel,” she said, “But you lucked out with this surgical team!” Holy shit! Had the anesthesiologist just allowed my ENTIRE birth team into the OR!? I thanked Dr. Hans profusely. Dawn had her camera, and asked me if it was ok if she took pictures. I complied.
“Do you feel any sharpness when I pinch you here, Ariel?” my doctor asked.
“Nope,” I reported. And the surgery began in earnest. First there was the sanity check, where the doctors all checked in. “Patient Ariel Stallings, here for scheduled caesarean for breech presentation.”
“Yep,” I said quietly, as the doctors confirmed the information. They weren’t asking me, but I’m compulsively helpful.
My mother wandered by at one point and put her hands on my temples for a moment before wandering off to observe the surgery. I called her back and asked her to keep her hands on my head. Andreas was holding my left hand and doing the hyponobirthing hand stroking, although we’d practiced it with him watching my belly to match the stroking to my breathing rate, and of course he couldn’t see my belly at all thanks to the surgical drape between my top half and bottom half. I was also a bit stymied in my breathing – the focus of hypnobirthing breath exercises is very much deep abdominal breaths, and I couldn’t feel anything below my chest, and understood in my head that the area I was trying to breath into was currently being sliced open. So I focused on my rib cage as much as I could.
I felt the moment when they must have sliced me open and started suctioning out the amniotic fluid. Even in the weird numbed state, there was an IMMEDIATE sense of relief. An IMMEDIATE sense of Thank fucking god I’m not pregnant any more. WHEW.
I’d done my research and knew to expect the strange sensation of the doctors tugging at me – since I knew it was coming, I didn’t find the sensation at all disturbing. In fact, it reminded me of being in ocean, being waffled back and forth between currents. Or maybe even of the time I did a Watsu treatment, which involved laying limply and being moved through the water by a practitioner.
Mentally, I was focusing my attention on being in a state of positive surrender and anticipation. Having my entire birth team there helped me feel deeply supported, and the fact that it was my OBGYN doing the surgery made me feel comfortable. There were no moments of fear.
Five minutes into the surgery, my doctor said “Almost got him.” Another woman’s voice (maybe the assisting resident? Maybe a nurse?) said “You’re about to have a baby boy!”
It was a statement of the obvious, but had the desired effect of making me smile and get excited.
“Here he is,” my doctor called out, and then asked me “Do you want us to lower the drape so you can see him?”
I answered yes, and the drape went down and there was my baby boy, covered in vernix and goo and squirming and looking healthy and very pink. I have no idea what I said (was it “OH YAY!”? it might have been) but the baby’s response was to cough at me, which made me super happy. Again, I’d done a lot of research about c-section births, and had read that cesarean babies can often be sort of gurgly and slow to breath because the fluid hasn’t been pushed from their lungs by traveling through the birth canal. But here was my boy, coughing on me and crying right away – bright pink and healthy and big and awesome.
I got teary (but not crying) and then the baby was carried over to the warming table a few feet to my left to be cleaned. Andreas was with him the whole way (as agreed) and I watched as he helped the nurses dry the baby and wrap him in a blanket. My mother was still at my head, telling me all about how healthy the baby looked, how great his lungs were working, and other things you’d expect a midwife to notice. No “Oh he’s so cute!” but instead, “Ooh, look at that wonderful apgar!”
Then Andreas brought Tavi over to my head so that I could nuzzle his cheek. I was surprised at how quickly the baby quieted down – after a few yells during the drying process, he was wide eyed and calm. I’ve had many friends with colicky baby, and will admit I’d had moments of wondering, “What if the baby comes out crying and never stops!?. Dre held him close to me so that I could kiss his cheeks and say hello. Thankfully, my hands were not restrained during the surgery, and after a check with Dr. Hans, I was able to reach over and touch the baby’s face.
At a certain point in the process, I started feeling a little nauseas. Dr. Hans gave me some sort of medication, and I was informed after the fact that I was probably feeling nauseous because the doctors had just lifted my uterus out of my body (guh) and had set it on my belly (shiver) where they were stitching it up. Even if you can’t feel it, evidently someone reaching into your abdominal cavity and pulling out an organ can still make your body go HOLY FUCKING SHIT.
The nausea passed, and I was back to fawning at the baby. I was prepared for the fact that I wouldn’t be able to hold him right away, but felt great about how much of the remaining 40 minutes of the surgery the baby was in Andreas’ arms. The rest of the surgery went pretty quickly, since I could focus on the baby instead of the surgery.
I did call out at one point, “Dr. Austin?”
“Yes?” she said.
“Do you see any visual indication of why the baby was breech?” I asked.
“We were just talking about that,” she answered. “I don’t see anything physical that suggests why he was so stubbornly heads-up. He must have just liked it there.”
Then it was back to the recovery room for a couple hours. They put some heavy narcotics into my IV at this point, and I got nauseous and overwhelmed and confused. My mom’s partner and my father showed up, which was a little overwhelming, although I was happy they were able to be there, and thankfully everyone was focused on the baby so I could just lay there feeling drugged out and confused.
The baby was brought to me for breastfeeding (“Oh, Ariel!” my mother crowed, “You have the perfect breastfeeding nipples!”) and he latched on immediately, which was awesome. I was feeling less than awesome though, and barfed several times during the inaugural nursing session, while still keeping the baby latched on.
After a couple hours, they wheeled me to the post-partum room — that was the worst part of the whole experience, actually. The motion of the gurney moving down the hallway made me sick, but the nurses had failed to bring my little barf bucket with us on the trek to the postpartum room. “I feel nauseous,” I said.
“Almost there!” they lied.
“I’m really nauseous,” I said again, and then I barfed.
Thankfully, my many years of hard partying in my 20s granted me the enviable skill of swallowing back my own vomit rather than barfing on myself. I made use of this skill to avoid yakking all over the place as they wheeled me to the postpartum room, where I spent the next two days recovering and snorgling on my newborn son.
Part IV: Reflections
I feel good about my birth experience. It wasn’t what I wanted, but we did everything we could to avoid a c-section (seriously: if you’ve heard of a breech flipping method, I tried it. Twice.) and so I don’t feel any sense of failure or disappointment in myself for somehow not making an unmedicated vaginal delivery happen.
Part of this is feeling well-prepared both emotionally and logistically. I think there’s an understandable tendency, when working toward one vision of your birth, to avoid thinking about the undesirable alternatives. Unfortunately, I think this can result in feeling shocked and unprepared if the outcome doesn’t go the way you want – and I’ve had friends who’ve described their post-cesarean recovery as feeling like PTSD.
Since my c-section was scheduled, I had several weeks to do my research about what the surgery would entail, make arrangements for how to make it as good as possible, and prepare myself emotionally for the realities of a heavily medicalized hospital birth. A big part of this was releasing that I’d be able to control everything. I talked to a lot of friends who’d had c-sections and got tips and advice from their experiences.
I think we also just got lucky. I’m lucky to have an OBGYN I have a nice personal connection with, who was so caring with me through the process. We totally lucked out with having an anesthesiologist who allowed my entire birth team in. I still have no idea if my OBGYN pulled some strings for us, if the fact that the two extra people both had RN experience, or if Dr. Hans was just a nice guy. But it made a huge difference to feel so supported.
Although it was odd to be having these two discordant experiences simultaneously – on one half of the room was this deeply emotional moment of meeting my son, and then a couple feet away was full surgery. I mean, when was the last time you were WIDE AWAKE while undergoing major abdominal surgery? Let alone, being wide awake and having this intense emotional experience of meeting your child? It was discordant and a bit of a collision of emotions and logistics. I felt grounded through the experience, but was definitely glad when it was over.
I’ll repeat myself again here: Even if the surgery wasn’t the birth I envisioned, and if Swedish hospital’s operating room wasn’t the environment I’d envisioned, thanks to preparation and some luck, I did manage to have the emotional atmosphere I had envisioned for my son’s birth. And ultimately, that’s what matters most to me.
For that, I am thankful.