When Lightning Strikes

This is a re-release of an article I wrote several years ago.  The majority of the information still applies to all interactive support groups on the web.  When leaders from the ACOG community stand in front of a panel like the recent NIH VBAC Consensus Hearing and claim to be saving that “one baby” through repeat cesareans and setting an impossible standard that cannot be met for VBACs, this is what goes through my mind.  The personal loss and horrible tragedy that touches all of those families that experienced cesareans without medical indication which caused more pain and agony than can ever be replaced or healed through unreasonable protocols and restrictions of women’s choices for healthy birth.

On the ICAN-online Yahoo Group we are often accused of ignoring the risks in order to achieve an experience.  The reality is, we are all too aware of the risks we take.  In our world, they have names.  They are women we have lost or babies who have passed too quickly on.  We mourn for our sisters and when the risks are named, we picture “uterine rupture” not as a medical condition but as the face of our losses and cold, still black and white photos of those we yearn to hold one more time.
This issue is dedicated to unnecessary cesareans and the reason for this article is to count the cost of when lightning strikes.  The risks say, “.5% unless that uterine rupture happens to you, then the risk is 100%.”   This sounds terrifying and so incredibly personal and we try to wipe it away with the glib idea that if we had to bet on getting run over by a bus, we would take the 99.5% every time.  So the risk is placed on us and we live in fear of the risk, even as a background noise through a healthy pregnancy and delivery.  We remember our sisters and fear somewhere in small recesses that it could happen to us.
And yet, lightning strikes are not without the storm.  The lightning that struck Amanda and left her without her son would most likely not have happened without the failed induction that left her uterus damaged with a cesarean scar.  This was not the random event one would like to think in order to have peace and it was not caused by the attempt at VBAC.  The original damage was done by a cesarean she did not need.  The face of medicine today reflects that we are often blaming the mother for her attempt at a ‘dangerous’ VBAC and yet we rarely see the medical providers rail at an unnecessary first cesarean that falls out of a failed induction or a big baby scare.  We don’t see them out at the first sign of the storm, telling us to avoid the clouds and the severe weather.  We only see them when they stand over us in the aftermath, asking us why we didn’t see the lightning coming.
Placental abruption, uterine rupture, hysterectomy.  This lightning isn’t without cause.  The studies show us that for every cesarean, the stillbirth rates double.  We lose twice as many babies with the first cut, and four times as many with the second.  What happens when we have mothers having three and four cesareans?  We start taking them earlier at 39 weeks, raising their risks of early infant death in order to hopefully prevent those stillbirths.  And not knowing where lightning will strike, VBAC plans and trial of labor is severely discouraged in order to protect the mother and this baby, without regard to the next.  The storm continues building.  Is sectioning every mother with a suspected big baby or early induction worth this?  If the cesarean rate continues to grow beyond 50%, what does this say for the future safety of women or their babies?  Can we then expect to return back to the days of expecting more losses than living children?  Right now, we stand on the cusp.  We see the maternal mortality rates rising and see ourselves losing multiple women in our communities such as New Jersey for the same medical emergencies arising from their cesareans and managed births.  The doctors try to convince us that these are random strikes.  That no one knows and they did the most they could do to get a healthy mother and healthy baby.  One has to wonder if they are reading the same research or if they are simply trying to avoid taking responsibility for starting the cascade that continues to escalate and rob us of those things most precious to us.
This is dedicated to the ones we have lost…to Marcia and Logan, to Kimberly, to Deb and Fiona and to all the numerous others who blend into facelessness and pain simply because we fail to reduce the cesarean rate and stop the lightning from striking.

Originally printed in The Clarion, Summer 2008.

Surviving the First Birthday After a Cesarean

“Once a Cesarean, Always a Cesarean” never rings more true than when referring to a child’s birth. Even though a mother may later go on to have a vaginal birth or future healthy pregnancies, there is no way to step back into our footsteps in the snow and change that day in surgery. Sometimes, coping lasts a lifetime but there are critical moments in recovery in the first year that moms have to weave through and often, they are alone and unsupported. Most of the time, those close to them don’t even realize the impact of their words or actions, thinking they are sharing the moments with the new mother. On baby’s first birthday, many well-intentioned friends and family fail to see what is in front of them: a mother in mourning being forced into celebration.

A mom may ask herself if she’s even normal, because she feels so despondent or unwilling to plan birthday parties. She may throw herself into planning the biggest celebration possible, hoping it will drown all the pain out. The reality is, she often sees this is as the first anniversary of trauma. While not all cesarean moms view it this way, it’s important to understand how a mom could wind up in this emotional dilemma of baby’s birth vs mother’s birth experience.

Research shows that women remember their birth experiences for the rest of their lives. These stories impact not just today but the rest of their lives. A mother goes into labor and gives birth, remembering much of it while wrapped in the heightened sensations of labor.  She remembers specific smells, looks, people’s faces and attitudes and words. As she goes into labor or is induced, she is often afraid of the unknown or even the known if this is not her first labor. She walks into the hospital and deals with strangers she is forced to trust at the most vulnerable time of her life. In some cases, she doesn’t really like her care provider or her nurses. Then, as labor continues, something changes and she labors longer and harder and suddenly, a cesarean. This isn’t what she prepared for, this is surgery. She is drugged, she is strapped down, and she is often throwing up. Sometimes, she is not even conscious, depending on the circumstances. Unable to help herself, she watches the ceiling as her body is cut open and her baby is taken away. Often, the obstetricians and nurses discuss their day or other clients or even football games. This event that was hers and personal becomes distracted and impersonal. Her baby is born and she gets a glimpse before having the baby removed, wrapped, and only a face and then gone to the nursery. There is no physical contact to solidify this bond between mother and child. There is no orgasm of love and completion in each other’s arms that is so tactile and important for every being. She is left alone with the staff, cleaned up and moved to recovery.

At this point, her husband or partner goes with the baby. They share joy, “Look at his hair! His fingers, his toes!” They call family and tell of joy in the new little person. His size, his weight, his features. They take cell phone pictures and post on Facebook or blogs. They are building a vision of love.

A year later, they share this vision. They talk over and over about the day he was born or the first moments they saw her. They are overwhelmed by the joy of that moment and they relish in it. “I was the first person to hold her!” a grandmother remembers. As they share these moments, the mother remembers, “Everyone held her but me. And when I finally got to hold her, it hurt so badly, I could barely move. “ They pass around pictures of baby’s first few moments, none of which include the mom except one, with an upside down baby’s face, wrapped tightly in a blanket, next to her head while she feebly smiles. She thinks to herself that even in that moment, she didn’t get to hold her baby or touch, skin to skin and feel the baby newness.

This is the reality of the first birthday. These flashbacks and moments where only the mother , and she alone, remembers and recovers her own experience. So how can someone help a mother in this situation? How can you, help yourself? Here are some tips on recovering at that first birthday:

Listen.

The new mother needs you to hear her side of the story.

Talk.

If you are the new mom, talk about the birth. Find someone you can share this with and just talk. Many women turn to online support at this time just to be able to get it out and share with other moms who get it.

Accept.

It’s not only ok but normal to wonder things like, “Is this baby really mine?” or “I don’t feel like her mom, I didn’t give birth.” Many moms have asked themselves these questions. Accept for yourself that your child and you have moved past that day, even if you were not unaffected by it. The feelings surrounding the birth do not have to stop you from loving your child, bonding with them and helping you both to grow.

Feel.

You have every right to feel however you want to feel. You do NOT have to dwell on feeling grateful that your child is alive or that your birth occurred the way it did. You have the right to feel questioning of the outcome and ungrateful for the way things happened.

Express.

Talk, paint, feel, write letters to the providers about your care. Write out your birth story in the way you wanted it to occur. Cry if you need to. Have a day for yourself, treating yourself well and celebrating your motherhood while allowing yourself the freedom to see the day as a multitude of different occasions that happened to different people at the same time.

Ignore.

You can ignore a child’s first birthday. The subtle way to do this is simple: Move the date. Make the party on a day that has nothing to do with the actual birth. Celebrate a half-birthday instead. You can still use a 1 candle at 1.5! You can have a small thing at home with just a cake and you and baby, celebrating together and being special in a way you were denied the first time.

All in all, treat this as if it were YOUR day. This is not simply a birthday, deserving of a Blue’s Clues cake smooshed by a happy baby. It is also the anniversary of a transition in your life that you deserve to memorialize in whatever way best suits your personal needs.

Would you like to share your story or ideas for surviving the first birthday? Send your emails to director @ birthaction.org .