Warning: there will be some discussion of childbirth in this post, so,
if you’re only here for the knitting, I’d suggest that you look away now.
It’s also a bit of a long one…
Alright: I realise that most people don’t give two hoots about how I happened to transfer two small human beings from inside my body to the outside world, and my reading of STFU, Parents has given me all too keen an awareness of the dangers of over-inflating the significance of your own birth experience. This is my blog, though, and my introspective pregnancy-woe-venting session, so I’ll write what I like. Less flippantly, it’s certain that my experience of labour and birth the first time around had a substantial negative impact on the way I coped in the immediate aftermath of the delivery, and on my post-natal mental health in general. As such, I think it’s a topic worth addressing.
When I was expecting Ronan, people would ask polite questions about the pregnancy, and how I planned to give birth. How I felt about my answer would depend on where on the emotional and mental curve I happened to be at that point, but I almost always found myself having to defend the fact that I was not going to attempt a VBAC. Sometimes the questions and my responses were both calm and rational, but at other times I felt very judged for having a Bad Medicalised Birth™ rather than the empowering, natural VBAC for which I should have been striving.1 It didn’t matter that the exigencies of carrying and delivering a baby when one has gestational diabetes put me in a position where a Caesarean was the only realistic option, or that the circumstances of Eoin’s birth led more than one consultant to suggest that it was highly unlikely I could ever have delivered naturally. There was frequently a sense that I was in some manner taking the coward’s way out, or that I was putting myself and my body through a hideous surgical process when I could, instead, have been doing The Right Thing. A Caesarean section is very often perceived to be a failure, an artificial process, and a bad birth, while the natural, low-intervention route is seen as the only way to have a good birth. While I would never wish to judge anyone’s birth practices, and while I am delighted that so many women have empowering, successful VBACs, I would hope that my experience demonstrates that it’s possible for a repeat Caesarean to be empowering and successful too. First, though, I should explain what went wrong the first time around.
A Bad Birth
So much of our experience of pregnancy, birth and motherhood consists of striving to do The Right Thing, and to measure up to some hypothetical gold standard of parturition, as nebulous a concept as that might be. When I was expecting Eoin, I diligently went along to NCT classes. Most of the other attendees were planning low-intervention, midwife-led births (a lucky few even ended up getting them), but, having just been diagnosed with gestational diabetes, I was very aware that my experience was likely to be medicalised, and, by extension, compromised from the start.
Particularly at NCT classes, people talk a lot about the “cascade of intervention” in childbirth: briefly, the idea is that any medical practice used to hasten a delivery can and will have a negative impact on the rest of the process. Once some form of intervention has taken place, it is likely that you will need another and another, until you find yourself strapped into a set of stirrups on an operating table, drugged up to your eyeballs, while a team of surgeons gets to work on your nether regions with a set of Kielland forceps. Understandably, this is something most of the other members of the class were keen to avoid, but it was something that I knew I was likely to have to face. Because of the diabetes, and the concomitant gigantic baby I was supposed to be harbouring,2 I was to be induced two weeks early. I felt rather guilty as I explained this to the group, and, although they were all extremely supportive and non-judgemental, I already felt as if I had failed.
As it happened, I needn’t have worried about the induction. I unexpectedly went into labour three weeks early: the contractions started on a Thursday as I was, symbolically enough, baking bread with a friend. As we sat in her kitchen, drinking tea and admiring the loaf (which, of course, I couldn’t eat because of the diabetes), I noted that I seemed to be having a lot of Braxton Hicks contractions, but that I was sure it was nothing to worry about. Things got a lot tougher over the next couple of days. On the Friday, I was having contractions every ten minutes or so, and finding it rather difficult to do anything useful, like eating or sleeping. By Saturday, the contractions were every three to five minutes and things were getting pretty serious. Somehow, though, and despite all evidence to the contrary, I was still convinced that they were Braxton Hicks, or at the very least the earliest stages of labour. By 4.00am on Sunday morning, though, I had had enough, and we ended up in a taxi to the hospital. I was still terrified that this wasn’t “real” labour (I didn’t think it was bad enough, which suggests I either have an unexpectedly high pain threshold, or I’m a closet masochist), and was pretty certain the hospital were going to send me home to wait it out for another week before they performed the induction. The taxi driver, however, was pretty firmly convinced that this was the real thing, not least because I was sick twice during the ride to the hospital.3 When we got to the labour ward at 6.00am, I was surprised to be told by the midwife that I was 8cm dilated, and that I’d have my baby in no time. There was some congratulation for the fact that I’d got this far on a couple of paracetamol, a hot water bottle, and a half of mild in the pub on Friday evening. Then, everything went wrong. I kept having the contractions, but no waters broke, no transition happened, no baby arrived. Things got more painful, and I got more exhausted: I had, by this point, been in labour for three days, and I didn’t have anything left to give. Sometime around one in the afternoon they told me to push, and I pushed, dutifully and fruitlessly, for two hours. It became apparent that I wasn’t getting anywhere. The midwife gave me the gas and air mouthpiece back while the doctors tried to decide what to do with me, but by this time it wasn’t having much of an impact on the pain. At one point I must have passed out: I remember dreaming, being brought round by another contraction, and thinking, Father Jack-like, “Oh, God, am I still in this fecking hospital?!” I had a very clear sense that the only way this would ever end was if I died: it wasn’t that the pain was unbearably bad, even at that point, but rather that it had been going on for so long, and there was nothing I could do to get the baby out and make it stop.
Being taken for the emergency Caesarean section was a bit of a blur: the midwife, who had been monitoring Eoin, lost the trace on his heart, there was a bit of a commotion, and suddenly my bed was being pushed down the corridor into an operating theatre. I wasn’t even aware of the section itself happening: it seemed as if one minute I was being prepped, and the next, Eoin was being lifted out, fist-first like Superman. In many ways, though, the operation was the best part of the whole business. I was exhausted, stunned and, I think it is fair to say, somewhat traumatised. I was convinced that, somehow, I hadn’t really given birth to Eoin at all, rather that something had been done to me while I wasn’t really aware of it, and now, suddenly, there was this angry, hungry creature to deal with. I had enormous difficulty bonding with him: the guilt of this disconnection, combined with the guilt of having had the section in the first place, of having been diabetic, of having failed to breastfeed him, all piled on top of the other mental and emotional issues I had in the postnatal period to tip me into a very lengthy bout of depression. For a long time I was too scared to contemplate having another baby, and, when I was pregnant again, I was terrified of facing the same situation.
Eoin, a few hours old and none the worse for having been delivered by EMCS. Photograph by Stephen Lynch.
A Good Birth
Fortunately, my experience with Ronan couldn’t have been more different. I suppose I should be thankful for being diabetic in my second pregnancy, because it took the responsibility for making a decision about the method of delivery entirely off my shoulders: it is NHS practice to induce mothers with gestational diabetes early, and, as a (temporarily) insulin-dependent person with a history of previous Caesarean delivery, such an induction would not have been recommended for me. The best advice was that I should prepare myself for an elective section, and the doctors hoped I was not too upset at not being able to try for a VBAC. Upset? I was so relieved I could barely believe it.
I was, understandably, far more aware of what was going on during this second delivery, and, inevitably, I have to admit that it wasn’t a particularly private experience. I think there were probably twenty people in the operating theatre along with me, many of them students, and there was a slightly comical moment in which everyone in the room, including me, had to introduce themselves to the others. In the blur of the emergency section, I don’t think I had registered that the operating theatre was just a small room in the middle of the delivery unit: in my mind, it seemed much more separate and strange. This time, being taken for the operation was almost alarmingly prosaic: I walked down the corridor in my hospital gown and slippers, thorough a door that looked much the same as all the others, and spent a little time having a chat with the medical staff. The only jarring thing was the presence of the very large operating table on which I was shortly to be sliced open. Of course, a Caesarean is never going to be comparable to a water birth in a candle-lit room with soft music playing, but frankly I don’t think anyone would expect it to be. Yes, there was an operating table, and yes, there was a huge tray of ominously sharp-looking sterilised instruments. Yes, it did feel a bit as if the world and their dog were in the room with you. But I can say with complete honesty that my procedure was relaxed, calm and, believe it or not, thoroughly enjoyable. People were friendly and informative, and explained every step of the operation to us. I wasn’t particularly bothered about having music playing, but this would certainly have been possible if I had wanted it. In fact, the only thing I was determined I did want was as much skin-to-skin contact with Ronan as possible, as soon as possible after he was born. Fortunately the medical team were quite happy for this to go ahead, so, unlike the first time around, I was put back together again while holding a small, warm and slightly confused person against my chest. I really can’t underestimate the importance of this skin-to-skin contact: I understand that sometimes, when there are serious medical complications, it isn’t possible. But Eoin, notwithstanding his somewhat early arrival, was perfectly healthy at birth, and I really wish I had pushed harder to be allowed to hold him this way too. I had a great deal of difficulty bonding with Eoin, and this in its turn exacerbated the problems I had with depression and anxiety. With Ronan, again, it was completely different: as I held him in the operating theatre, it would not be too much of an exaggeration to say that I could feel myself bonding with him, minute by minute.
Ronan, one day old, and also quite happy to have exited through the sunroof.
If you have spent any time reading around the topic, you will no doubt have realised that there is a very unhelpful rhetoric surrounding childbirth, along the lines that we can control our experience almost perfectly if we are knowledgeable, prepared and driven enough. Now, I am not for a moment suggesting that knowledge and preparation are a bad thing, but ultimately, however many books you read, and however many hypnobirthing classes you attend, they aren’t going to outweigh physical factors like the shape of your pelvis, or the size of your baby’s head. I have two friends who planned for drug-free home births. Both were similar ages, fit and healthy, well-informed, and thoroughly prepared. One was lucky enough to have the natural home birth she wanted. The other, however, ended up with a lengthy and traumatic hospital birth. What did those two women do differently? Nothing. The mother with the hospital birth: did she just not try hard enough? Did she somehow not deserve the birth she had prepared for? If she had only wanted the home birth a bit more, she could have made it happen, right? Nonsense!
Unless you are very lucky, childbirth can entail a loss of control over what happens to you and your body. For many people, myself included, an emergency Caesarean might be a life-saving procedure, but it can also be traumatic and can leave you feeling as if you have lost all power and agency. For many mothers, a successful VBAC can be the experience which allows them to exorcise some of the demons left behind after such a difficult delivery. However, an unsuccessful VBAC can pile one failure on top of another: given my diabetes, and the long, difficult and ultimately fruitless labour I had had with Eoin, this was simply not something I was prepared to attempt. After a difficult birth, the main thing you are tying to do in a second delivery (apart, of course, from ensuring everyone is safe and healthy) it to regain some of the agency which you lost the first time. A VBAC can be empowering, of course, but, properly handled, a Caesarean section can be too. I wouldn’t have changed my experience of Ronan’s birth for the world, and I am very grateful to have had one birth on which I can look back with happiness, even if that birth was not the one that conventional wisdom told me I should have wanted.
1It’s important to note that, in the vast majority of cases, the critical judgements came from people who didn’t know me and my situation well.
2I was told that, at 36 weeks gestation, Eoin was already well over ten pounds in weight, and generally off the top of the scale as far as size was concerned. Born at a pretty average seven pounds, he turned out to be a small baby with a ridiculously big, heavy head. Those ultrasounds don’t always give you the whole picture…
3Don’t worry: I had brought a bag with me. The taxi was unblemished at the end of the trip.