A “Natural” C-Section
In the bright white light of the operating room a clear voice rang out above the fog clouding my mind: “You have a beautiful appendix!”
While I was heartened to hear the news, it wasn’t part of the script I’d imagined for the magic moments that were sure to pass in the immediate wake of my son’s birth.
I spent nine months envisioning a birth at our local Birth Center, supported by my husband, doula René, and one of the midwives I’d grown to love in all our prenatal checkups. I imagined myself bouncing on a birthing ball, laboring in the bathtub, swinging from the birth swing, and bearing down on all fours in one of the beautifully designed rooms. I clocked 12 hours in natural birth classes with René and another three in a comfort measures class to learn the best methods to get through labor. Pelvic floor therapy and corrective exercise prepared my body for the final release. I bought a TENS unit in anticipation of back labor. I meditated on the birth to come and read Ina May’s Guide to Childbirth to get my mental game squared away for the marathon that would culminate this chapter and start the next. I chose “transcendent” as the word that would center me in my labor to come, transcending from my current state of being to that of mother.
I cobbled together a prayer to keep with me during the labor:
Grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
Thank you for the gift of new life.
Grant me the strength and endurance I need to keep going during labor.
Bring peace to my mind and my heart as I journey through childbirth.
Help me to find comfort and rest.
May I trust my body to do what it already knows.
May I be filled with joy as a new life enters the world.
May I rely on grace, compassion, and love to help me.
When I felt my first Braxton Hicks I cried out in excited delight—and actual literal tears. My body was practicing and getting ready. I wrote out a detailed birth plan that included a wide array of possibilities, per René’s instructions. I knew an emergency c-section was a possibility, but I only included it in the plan because it was part of the assignment. I knew my body was made for birthing. I was convinced beyond all doubt that I would bring this baby into the world “naturally.”
If you can’t tell, I got really into the potential magic of a “natural” birth.
Excerpt from our original birth plan: I am incredibly eager and cautiously optimistic while open to the multitude of possible scenarios that could occur in our upcoming birth. This is my first birth, and I want to be as crystal clear about my wants and desires as possible so the birthplace staff can be clear, too. Both I and my husband, Brent, are aiming for a natural birth with the least possible medical intervention. We are prepared for the unexpected, and this birth plan is meant to help us convey to you what we want while our minds are clear and unexhausted.
We want to give informed consent before any procedure or intervention takes place.
While we’ve thought through lots of possible scenarios, there could certainly be unforeseen/special circumstances, and I expect to be given clear expectations, medical needs, and all options before next steps are taken.
My husband and I will have the ultimate decision making power, and we will lean heavily on the counsel of our midwives and doula for all interventions.
At our 20-week anatomy scan, baby was already head down. This was very encouraging since, ya know, babies are meant to be head down to make their way out. At our 33 week 4D ultrasound, baby was still head down in perfect position for birth. At our 36 week appointment, there was no ultrasound, but baby was measuring a little small (34 weeks), and our midwife performed a cervical exam just to see what she could determine. She found that I was 50% effaced and already dilated 2 centimeters. She assured me I could easily stay there all the way to 40 weeks, but that this was extremely encouraging. My body was ready. I started getting even more excited: this was real.
And then our 37 week appointment hit: an inflection point. The hitch in our get-along. Baby was still measuring small, so our midwife, Elizabeth, recommended we do an ultrasound to ensure fluid levels were okay and baby was getting the necessary nourishment. I’d been anxious since the week before when baby was measuring small, so I was plenty eager to take a peek under the hood as soon as possible. Lucky us, the ultrasound wizard, Jamie, was in and had an opening, so she ushered us into the ultrasound room for a quick tour of my uterus. Within moments she had the device sliding around on my belly, and she moved it right underneath my right rib cage and then paused.
“Don’t panic, but that’s baby’s head.”
I laughed in disbelief, “But baby’s head is supposed to be down…”
At 37 weeks, my darn baby decided to flip to breech. My body, so ready and primed for a “natural” birth, was now a liability. If I went into labor with a breech baby, there’d be an emergency c-section or broken baby collarbones or worse.
I don’t think I understood the gravity of the situation at first. Brent and I went back into one of the midwife’s exam rooms, and the midwives and staff, and René, who just so happened to be at the Birth Center at this time, came in to talk with us and walk through what this meant. I’m one to be eternally optimistic, so my initial thought was… well, baby has been head down this whole time. Why would they flip? And won’t they just flip back again?
It turns out it’s not that easy. As baby gets bigger, it gets more difficult for them to make big maneuvers like a full flip. So we started talking options, and I learned a term I’d never heard before (but was about to get a crash course in): “she’s a good candidate for an external version”
A quick Doctor Google explanation for those who need it like I did: An external cephalic version is a procedure used to turn a fetus from breech to head down before labor begins. A successful version makes it possible for vaginal birth, but it’s not a widely accepted procedure and few doctors are willing to perform it because in 2% of cases it ends badly. (Keep in mind that 2% of c-sections end badly, too.) External versions have a 50% success rate, and Dr. Dickerson, owner and medical director of the Birth Center, has a pretty high success rate. He knows what’s up. At 37 weeks and 6 days, it was the furthest along gestationally that a version is typically attempted. But my fluid levels were great, there was plenty of space to attempt, and baby was still a twee little peanut.
Between Wednesday, May 26th, and our scheduled version on Monday, May 31st, I had time to do everything within my power to encourage my baby to flip—and I took that assignment seriously.
I tried Spinning Babies inversions, which included me lying on an ironing board propped up on my couch at a 45 degree angle, placing ice on the top of my belly, and playing Vivaldi’s Four Seasons through earphones to the base of my belly, moxibustion (a type of traditional Chinese medicine where I burned mugwort leaves near my pinky toes to stimulate my qi—and also make my pinky toes look like charbroiled steak), and long walks. I took warm baths and talked to my baby, letting them know that I wanted to have a “natural” birth but that wouldn't be possible unless they decided to flip. I floated in my pool and imagined baby flipping as I drifted weightlessly. I did hypnobirthing breech baby meditations. I left no stone unturned.
I am the type of person that, as long as I have a plan and hope for change, I go all in and believe it will happen. So I went into Monday’s version confident that, if I hadn’t flipped the baby myself, the version would absolutely work.
And then on Saturday, May 29th, my body started contracting. We were driving home from Whole Foods and I felt cramping in my low abdomen. It wrapped around into my back as Brent chatted to me about cryptocurrency. We got home and I unloaded groceries and then went to lay on the couch. The contractions started getting more intense, and I hesitantly alerted Brent. He came down and hooked up the TENS unit to my back, and I timed the contractions for one hour. After an hour, I called our doula René and let her know what was going on. I knew if my body was going into labor and my baby was still breech, it would be bad news bears. So we headed up to the Birth Center, our baby bags packed just in case, for another ultrasound.
Baby was still firmly breeched, and I was now 4 cm dilated and 70% effaced. The recommendation: stop everything. No more inversions. No more walks. No more red raspberry leaf tea. No more dates. “Without using the phrase bed rest, you need to do nothing until Monday’s version to stand a chance of making it ‘til then.”
So, needless to say, Sunday was hard. Being a person who likes to DO things to effect change, I had to settle deeply into just BEING. I can’t even remember what I did that day, but the contractions eased and we made it to Monday’s procedure. As I went to sleep on Sunday evening, I was convinced that by the same time the next day we’d have a flipped baby.
We packed up our baby bags for a second time and rolled into the hospital on Memorial Day to a skeleton crew and quiet labor and delivery floor. I did my best to stay positive and chipper as all the things began to happen that I didn’t anticipate being part of my birth story. A hospital bracelet placed on my wrist. Being handed a plastic bag for my clothes and a scratchy hospital gown. Having an IV port inserted into my left arm. Fetal monitoring belts strapped onto my belly. They did, thankfully, let me keep on my snuggly socks I’d brought from home. My one item from my baby bags packed for labor that I got to use in room 2233-A of Woman’s Hospital.
Dr. Dickerson came in and spoke with us at length about the version he was about to perform. He answered every single question we had, and then they administered terbutaline into my left arm to relax my uterus. Brent held one of my hands, and at some point, I felt another hand grab my right hand—René. As Dr. Dickerson began the version, my eyes squeezed tight and it was all I could do to keep breathing as tears involuntarily streamed out of my eyes.
Physician note: ECV attempted after terbutaline given. Frontward roll version performed twice without success. FHTs in the 80s afterward for 2 minutes. Fetus recovered back to baseline. A third attempt trying a backward roll was performed without success. FHTs were reactive and reassuring after the third attempt. Will cease attempts at this time. Will monitor for 2-4 hours depending on FHTs and will hopefully discharge home with follow-up tomorrow.
What the physician's note can’t capture is the silence in the room in the 2 minutes after the first attempts were made when we heard zero heartbeats on the fetal monitoring. And the agonizingly long and slow ascent of baby’s heart rate until it got back to baseline. And then the decision to try again. The procedure was painful in my body, but even worse was this feeling in my gut that everything about this was wrong. This wasn’t the plan.
Baby has a strong will and did not want to flip.
Dr. Dickerson sat with us afterward in our stunned disbelief that it didn’t work. The only thing to do at this point was to schedule a c-section for the following week. When Dr. Dickerson, owner and medical director of the Birth Center and also proponent of home births and midwifery, recommends a c-section—you listen. I had 8 days before the scheduled c-section to toe the line between doing everything in my power to flip baby AND not induce labor.
The next week is a bit of a blur. I was still working, but my kindhearted boss encouraged me to just go ahead and start my maternity leave early (I was kind of a hot mess express, anyway). While the distraction of work was helpful, I decided to get back to just BEING with my body. BEING with my baby. I continued spinning babies and moxibustion and icing and Vivaldi and added in acupuncture (with electric jolts to my baby toes and small seeds placed in my ears) and visited my chiropractor and did uterine ligament release with my pelvic floor therapist. I wasn’t sleeping very well at this point, and I recall one 3 am prayer of desperation:
“Okay. If I have to have a c-section… FINE. But at least make breastfeeding easy, okay?”
The c-section was scheduled for Wednesday, June 9th, at 7 am. At this point, I finally mentally surrendered to a c-section and accepted in my heart that this baby was choosing to enter the world via a c-section.
As any good planner would do, I came to this place of peace gradually. I experienced all the stages of grief.
Denial: when I thought I could control this situation and encourage the baby to flip.
Anger: Oh yes, I was incredibly angry. I was even angry at the baby at one point, as much as I hate to admit it.
Bargaining: see the above comment about the 3 am c-section/breastfeeding bargain.
Depression: apathy, tears, deep sadness. All that jazz.
Acceptance: I made a "pros and cons" list:
C Section Pros:
We get to schedule it, so I get to plan. (I love to plan)
I’m grateful this is an option and I don’t have to deliver a breech baby and worry about that survival rate.
We don’t have to worry about my water breaking somewhere in the house and making a mess.
We will be at the hospital already so we don’t have to drive to the pediatrician 24 hours after birth; the pediatrician will come to the hospital.
I’ll have more peace of mind/maybe sleep those first few nights because I’ll be at the hospital already if anything goes wrong with baby.
There will be a lactation consultant present while we’re at the hospital to help with breastfeeding/first cluster feed.
We get to order our meals and have them brought to us. (I hear the hospital’s cafeteria is amazingly good.)
When we come home we’ll feel more recovered.
Brent doesn’t have to worry about me screaming or loud noise or long labor he can’t sustain. (chronic illness)
Happy healthy baby.
Things I’m Sad About:
No skin to skin immediately/me holding my baby. I really want that. I even thought maybe I could catch my own baby.
I don’t get to labor.
This may be my only chance to deliver vaginally, and it’s mourning something that just may not be.
I was really looking forward to experiencing childbirth, and I just feel like I won’t be a full mom/woman. (Note that I’ve never thought this about anyone else who divulged they had a c-section; if anything major abdominal surgery is a boss move. But it’s different when the voice of judgment is turned toward the self.)
My whole life people have told me I have child birthing hips, and I just assumed it would be easy for me. Baby has other ideas.
Comparing myself to other women who deliver babies vaginally.
Already received judgment from children. Just don’t want to have to talk about it and explain it all the time.
Not getting to have the Birth Center experience (no “welcome baby” post or cinnamon buns. Feeling like a Birth Center dropout.)
Having to deliver in a hospital with bright lights and lots of medical equipment and... hospital stuff everywhere.
A c-section seems like an alien autopsy.
Having to stay in the hospital for days.
On Tuesday, June 8th we had one last appointment scheduled with the Birth Center to see if baby had flipped. Spoiler: baby had not flipped.
Excerpt from C-Section Birth Plan: Now that we know we have a scheduled C Section with Dr. Dickerson, I’ve amended my birth plan to be inclusive of just this one scenario for ease. While a caesarean was never our goal, our goal has always been a healthy birth, and with a breech baby, this is clearly the correct choice. This is my first birth, and I hope to make the most of a cesarean, even if it wasn’t our vision. My husband, Brent, and I were aiming for a natural birth with the least possible medical intervention, but fortunately we prepared for the unexpected, and this birth plan is meant to help us convey how a cesarean could look, in the best case scenario.
We want to give informed consent before any procedure or intervention takes place.
I expect to be given clear expectations, medical needs, and all options before next steps are taken.
My husband and I will have the ultimate decision making power, and we will consult with Dr. Dickerson for all interventions.
So, on the eve of our scheduled c-section, we headed home to enjoy our last evening together. Just Brent and I.
And then I went to the bathroom… and there was blood… and I was having constant contractions. I called the Birth Center and before I knew it we were heading to the hospital, baby bags packed a third and final time, for an immediate c-section with a different doctor, Dr. Thomas, because Dr. Dickerson was unavailable.
I suppose, one last time, baby wanted to throw us a curveball.
We blasted Queen’s “Don’t Stop Me Now” on repeat on the 15-minute drive to the hospital. René met us in the admitting area. The rest is a blur of IVs and a flurry of nurses and saline drips and a blended feeling of excitement and dread and bright white lights and an epidural and tugging and then there was a baby boy named Finley (Finn for short).
And while it doesn’t matter how he got here, he’s here and he’s wonderful and I’m so in love (and breastfeeding HAS been relatively easy), I still find myself processing and mourning the loss of a “natural” birth. I’m no longer even a little bit angry at Finn—how could I be (or ever have been) with his precious squish face?—I do find myself going through the stages of grief on a loop as I process.
I’m grateful for an extremely healthy and loving baby. I’m grateful for the team of supporters who helped us through this tough time. I understand that even vaginal birth can be traumatic. We’re lucky to have had a planned c-section rather than an emergency c-section. We only had to stay in the hospital for two days and then we were home. One of the midwives, Amanda, even brought us cinnamon rolls at the hospital. And, as my midwives like to remind me, I’m a perfect candidate for a VBAC. But even that, should it come to pass, will have to be at a hospital, so I’m still mourning the lost potential of a Birth Center birth and all I had built that up to be.
There is so much to be grateful for, and I am. I understand the privileged experience I had to even be able to entertain a Birth Center birth, the healthy pregnancy I had, and the treatment and care I received in the hospital that my privilege affords.
And yet there is and will always be a little bit of a scar here. Both physical and mental. Mourning for what was hoped for but didn’t come to pass. I won’t “love and light” my way through this with “good vibes” only. I will deal with the pain, strong feelings, shock, stress, trauma (whatever you want to call it) head-on—confronting the difficult emotions and allowing myself to just BE. Messy, in pain, and mourning the “unnatural” birth that we had while also celebrating the love I feel for our new family.
It turns out my labor and birth process wasn’t so much in the delivery room, as I’d imagined, but in the weeks leading up to Finn’s arrival. It wasn’t as much a physical labor but rather a mental and emotional one. And maybe, in my own way, this was the transcendent labor I was looking for, even if it didn’t look like I expected it to look.
Mother's note: I decided to put “natural” and “unnatural” in quotes throughout this to emphasize the pressure I put on myself (and that I think society inherently places on women who do endure c-sections, for whatever reason) to be “natural.”
Also endless gratitude to René, who joined us for every step of the appointments leading up to the c-section, the midwives and staff at the Birth Center who showed unending support and led us to feel genuinely cared for (shout out to Amanda for bringing us cinnamon rolls at the hospital), and the hospital nurses and doctors who made the very best of an unexpected situation, especially Miranda, who made sure no one entered our room without her permission, and Mary, who was experiencing her first c-section patient post-orientation.
