Dodging the Scalpel

Last Wednesday, March 10 2010, at 7:35 in the evening, my daughter took her first breath of earth’s air. Mama and baby were unusually healthy. Baby’s apgar score was 9 out of 10, and other than a pesky I.V. pushing fluids and some antibiotics into my system, I was perfectly healthy.

Everything was just as I had hoped. Just as I had planned. So why did I feel as though I’d just dodged a bullet? Well, to be perfectly honest - because I HAD.

This was my third pregnancy. My third delivery. Third time is the charm, right? I was just happy that is wasn't strike 3 and you're out! As soon as my baby was placed on my chest, the relief of successfully delivering her without the interference of medical interventions was immense. Until that moment I hadn’t fully appreciated the elevated level of mental stress that had become a daily part of my life since I saw 2 pink stripes on that little white stick last summer. You see, my first baby was delivered in a hospital, and my second was born in a Birth Center. My hospital delivery was a medically managed nightmare in which I very narrowly escaped a cesarean section, and it al began innocently enough with a suggestion by my Obstetrician about inducing labor.

As many at 40% of all births in the United States of America are induced, “even though this leads to longer and more painful labors and “ups a woman’s chance of a [cesarean] section by two to three times.” (Wellesley) Without going into too much detail, I learned a valuable lesson which was later collaborated by my own research on U.S. birthing practices, one intervention tends to lead to another which leads to another culminating in a downward spiral that leads directly to a very complicated birthing situation, if not to major abdominal surgery (aka c-section).

Pregnancy and child birth are natural, normal processes. They happen everyday, all around the world. It’s been happening since the beginning of time. Pregnancy and childbirth are not a mortal threat - most of the time. For those rare occasions when they become dangerous for mother and baby thank God we have the medical advancements and highly trained surgeons necessary to work towards a positive outcome. But these extreme cases are not the norm. Most labors are able to proceed to a positive birth without any medical intervention at all.

According to the World Health Organisation (WHO) a country’s national rate of cesarean section should ideally be around 10% or less, and not higher than 15%. The United States’ rate of cesarean births is currently hovering at around 33%.

There are, of course, legitimate reasons for a cesarean. Fetal distress accounts for 9% of all c-sections, while 14% are performed due to either prolapse of the umbilical cord, placental abruption or placenta previa. (Answers)

However, the most common reason for having a cesarean section is that the woman has had a previous c-section. (Answers) This logic is circular and doesn’t apply to first time mothers or anyone else that’s never had a c-section. So onto #2.

The second most used reason (30% of all cases in fact) for a woman to endure major abdominal surgery in order to deliver a baby is “labor dystocia,” also known as “failure to progress.” (Answers) What exactly does failure to progress mean?

Failure to progress is loosely defined as “no fetal decent of cervical change (with adequate contractions) for more than two hours.” (PregnancyToday) More specifically defined as “cervical change of less than 1 centimeter/ hour for 2 consecutive hours. (Medical-Dictionary) Essentially “failure to progress” has become “failure to progress on the doctor’s schedule.” (Wellesley)

Failure to progress is a phrase that is used to influence healthy women who are carrying healthy babies to surrender their normal labor to the hands of surgeons on basis other than a lack of cervical change in a span of 2 hours. What is truly shocking is that given this definition and handy excuse to occupy these highly skilled surgeons (which is what an Obstetrician is, a surgeon) is that anyone is born vaginally in the United States at all!

The mountain of medical intervention that occurred with my first birth led me to a Birth Center and a Certified Nurse Midwife (CNM) for my second birth. The term “failure to progress” terrified me into action when I learned I was pregnant last summer, after my local birth center (only 1 of 2 in the entire state of North Carolina) closed to births due to rising insurance costs (despite having been open for 25 years and never, ever having had any negative birth outcomes.) I interviewed 5 offices and 2 midwives before deciding on one and rejected 2 hospitals before settling for a third. I’d done all I could do. I found a hospital that allowed Certified Nurse Midwives to deliver and that didn’t totally repel me. I’d found a CNM that I believed I could trust with my life, my life of my baby and would safeguard my labor from unnecessary medical interventions.

So, last Wednesday, my baby decided it was time for her grand entrance. My water broke in the morning and by 12:00 pm I had been admitted to the hospital. Baby’s heart rate was monitored for about twenty minutes and then I was free to labor in the tub, watch television, walk around, whatever I wanted to do. I was fully effaced, and my cervix was 5 cm dilated. Two hours later, 2:00 pm, I was still 5 cm dilated. Two hours after that, I was 5 cm dilated. At 6:30 pm (six and a half hours after I was admitted to the hospital for labor) I was STILL 5 cm dilated.

I was failing to progress. According to the medical definition of how labor is supposed to occur, I should have a cesarean section. Some doctors might have begun pressuring me at 3 in the afternoon. And I was quickly spiraling into a panic. At around 6:30 pm my midwife suggested that we start to consider a pitocin drip. Pitocin is a medial intervention. It’s the first step down that rabbit hole of medical interventions that ends not with “off with her head” but with “Scalpel, please.”

It was not labor that made me break down and cry, it was not the failure to progress, it was that one word - pitocin. And my midwife reassured me. We didn’t need to do it yet, and if we decided to add it we would only need a small amount to “get me over this hump”. I clung to her promise the it wasn’t yet necessary, and she went to work on midwifery secrets that OBs only WISH they knew. She had a labor and delivery nurse there and she began to talk her through pressure points to aid in my progress. Shortly before 7pm I moved to the rocking chair and began to rock, and relax. My midwife went to work on my neck. Massage and pressure points. It felt great until... whoa momma... transition! The contractions became powerful and very uncomfortable. And when I, the anti-intervention Queen, looked at my midwife and told her to get me an epidural she encouraged me to get on the bed so she could check my progress.

After 7 hours of “failing to progress” I was now over 8+ cm dilated and at 7:35 pm, after 3 pushes, my perfect baby girl was placed on my chest.

Labor is not text book. Labor is not a strict science. It’s a natural process that progresses at it’s own pace. Labor is as unique as the babies and mothers involved, and it SHOULD NOT be held in a tight framework and applied to mothers as though labor is exactly the same for each baby.

The relief washed over me, because I had done it. I had labored and delivered the way a healthy mother and healthy baby were meant to labor and deliver. And because I had, in a very real sense, dodged the scalpel.

What has been your experience with labor and birth? Did you give birth at a hospital? Did you have an OB or a midwife? I would love to hear your stories!

Zena

March 10, 2010

8 lb. 12 oz.

21 inches