Erin’s birth story
I can’t believe my friend Erin’s baby, Abigail, is almost three weeks old. Regular readers may remember that I had really enjoyed preparing to be Erin’s birth coach, which she asked me to do after I twisted her arm because I had some experience — five births — having a natural birth in a hospital setting.
However, things did not go well, and Erin ended up having an emergency c-section, only minutes after she arrived at the hospital. That was followed up by a 9-day stay in the NICU and Level II nursery for her dear sweet baby, Abigail Ruth.
Erin has said that I can post the birth story now, so…
(I wrote this the day after Abigail was born.)
When I was preparing to help Erin in labor, I had three main concerns:
- My education: I wanted to make sure I understood all the processes of birth that I possibly could, so that I could help lead my friend into good birthing decisions.
- My friend’s choices: I carried some concern that, no matter how I led, that in the heat of the situation, my friend would make unwise choices.
- The doctor’s motives: I was concerned that the doctor would make decisions based not upon a good outcome for Erin and her baby, but out of convenience, litigation-avoidance, and/or profit motive. (To a lesser extent, I was concerned about the nursing care Erin would receive, along similar lines of my concern about the doctor.)
What I didn’t even truly consider, deep in my heart, was that something outside of those three categories might happen. I didn’t really, truly think that something would go WRONG, unless it was from the consequences of my not knowing what to do, Erin making poor decisions, or undue interference from the doctor.
I received an e-mail from someone this morning who said that when she has acted as a doula, and that things do end up going south, it takes her a couple of days of reflection, prayer, and worship to pull out of it. Even before she wrote that to me, I found that to be exactly what I was experiencing.
Reflection: yes, thoughtfully so. Prayer: nearly continually, just offering up conversation to God, pouring out my heart, for my sweet friend, her dear baby, her husband, and myself. Worship: ha! I have had Telecast’s Beauty of Simplicity on repeat play and have listened to it countless times now.
What I have come to is this:
- After Erin had a c-section, I thought, “I must not have done my job.” But, actually, I did. I did it. When the nurse said, “Late decels” and I looked at the strip from the fetal heartrate monitor, I knew it was true. I knew it was serious, and when the nurses and doctor jumped on it QUICKLY and said, basically, “C-section now!” I knew that they likely weren’t jumping the gun. I knew what they were seeing on the monitors meant decreased oxygen to the baby. Reading up a bit, afterwards, I see that variable decels during a contraction are frequently related to umbilical issues, which will often resolve themselves with a better birthing position, and that the current theory is that late decels indicate placental insufficiency (though that does NOT appear to have been the case for Erin; her placenta was healthy). But at the time, all I could remember was that if she labored on her left side, or on hands and knees, that if it was due to compression of the vena cava, or from the umbilical cord being wrapped around the baby’s neck, oxygen supply would have a good chance of being boosted. But, that didn’t happen. The decels were getting worse, not rebounding as high, dipping ever lower. The baby still wasn’t getting oxygen. I knew that, when the nurses, then the doctor, said that they would have to do a section, ASAP, that they weren’t just creating an artificial emergency; it was an actual emergency; a section was truly warranted. This was made even more clear after the baby was born.
- Erin did everything right that she possibly could have. She labored at home as long as she could. She did wait for labor to spontaneously begin. She actually had prodromal labor for a good 24-30 hours. She waited until the contractions were 3 minutes apart and painful before going into the hospital. She didn’t make any poor choices at all, not at home, nor in the hospital. She did all she possibly could do. She only ever dilated to 1 cm, and there’s no way that was anyone’s fault.
- The doctor didn’t make any interventions, from ANY motives, until that c-section. There was no pitocin. There were no scare-tactic situations. There wasn’t any time for that. And, as much as I stridently believe that the c-section rate in the United States has crazily, needlessly ballooned to 31.8% due to bad policies regularly practiced in standard medical care right now, and that women need to have as natural a birth as possible, I found myself repeating to myself, “He was right. I’m glad he was there. I’m glad he acted swiftly. I’m glad he was a surgeon.” The nurses, too, did the right thing. (I am less pleased with the care from nurses that Erin received, but I don’t think that any of it negatively affected the outcome; I just wish, in a few separate situations, they had acted/done differently.)
What we found out after birth:
- Sweet baby Abigail had let go copious amounts of meconium while in the womb, rendering the amniotic fluid to have a “pea soup” consistency. She aspirating it deep into her lungs, and swallowed a lot as well.
- Her one minute Apgar was four. (Five minute was eight, thank God.)
- Her blood pH was 7.07. That is low. Very low. Very acidic. That happens when the baby is not receiving enough oxygen. If it had dipped below 7.00, Abigail would very likely have faced permanent neurological problems. The doctor told us that, in an oxygen deprived environment, blood pH drops 0.4 per hour. If my math is right, that means that within 12 minutes, Abigail’s blood pH would have dropped into the perilous range with long-term effects.
- Baby Abigail was truly in fetal distress, not due to the fault of ANYONE.
I find myself wondering how a midwife would have handled it, if Erin had chosen to birth at home. Not that Erin was ever considering that, that I know of. But, when you’re looking at a window of opportunity, of NEED FOR ACTION, a window of less than 15 minutes… Could a midwife have transferred care to a hospital quickly enough?
Maybe a midwife would have handled the situation in a wise and speedy way, and everything would have been fine. Maybe with a simple fetoscope, she could have detected the late decels (combined with no dilation) much earlier than in a hospital, because it seems to me that most women who would birth with a midwife would be likely to call the midwife a bit earlier in the labor process. This is just my own conjecture, though. (Anyone with midwifery experience PLEASE feel free to chime in; I am abundantly curious.)
No matter how anybody else might have handled the situation, the experience leaves me with a better understanding of why so many doctors are anti-homebirthing. Erin’s birth was one of those situations that I’m sure play in the memories of doctors as they refuse to give their support to home birthing.
So… I’m still feeling very reflective about the whole thing. Not depressed, but very quiet and thoughtful. Even though I’m 98% certain that nothing could have been done in advance, or during labor, to avoid a c-section, there is still 2% of me that thinks, “There must have been something…” I’m still checking into a thing or two, just to make absolutely certain that somebody couldn’t have done something along the way that would have improved the outcome of Erin’s birth. But, I’m not dwelling on what-ifs; I simply want to file it all away in my memory, for the future… [Note: After talking extensively with two natural-birthing-minded L&D RNs, it doesn’t appear that there was anything that could have been done, though one nurse did say that she has seen a women labor for a long time with little to no dilation, frequently when the baby’s head is turned a bit to the side in a way that is keeping the head from sitting RIGHT on the cervix… but then the baby turns a bit, and WHAM! nearly instant dilation. However, even she agreed that though this may have been the case with Erin, the no-dilation PLUS late decels meant that Erin did, indeed, need a c-section.]
I think, though, that — though this birth SO wasn’t about me — I am left in a good place. Too many natural childbirth advocates rail with vitriol against OB/GYNs. I have read a lot of bitter rants, emphasizing the fact that they are surgeons, and that they’re simply chomping at the bit to perform surgery. I have read many startlingly bad statistics and countless birth stories of situations gone awry, caused by the mishandling of the natural birth process, primarily at the hands of OB/GYN surgeons and other medical caregivers who simply don’t seem to care — for one reason or another — for natural birthing at all. I have always said that I’m glad we do have doctors for true emergencies. But, somewhere in the back of my mind, I thought, “Are there true emergencies?? Do they even exist???” Well, now I know: there are. They do. And when they happen, I’m glad that there are surgeons trained to save the lives of babies who would surely — truly — otherwise be brain damaged or stillborn.
Again, not that the birth of Abigail Ruth was about me. But I feel like I’ve gleaned good from it. While I am still very much an advocate of natural childbirth, that is now balanced with first-hand knowledge that OB/GYNs do still (or at least can!) play a vital role in the successful outcome of a birthing experience.