Wednesday, November 25, 2009

Saying Justice

Over the last week or so, I've been thinking about all the things I'm happy about in my life: my husband; kids; family; friends; the fact that I am able to be home to raise my kids (and homeschool them, too!); my husband's new job (and the old one!); the thinking and writing I've been doing on the blog; the health of me, my family, and friends. All really wonderful things!

Then two things happened nearly simultaneously. First, I read Craig Biddle's piece entitled "Don't Say Grace, Say Justice". (Go read it!) Second, someone I barely know made a snarky comment about a subject that is very close to me: surgical births. This person was not directing her comment at me, but was making a general statement about a recent event where a woman happened to have had a c-section scheduled, but ended up delivering vaginally.

Excuse me for a moment while I venture into Mommy Wars territory. You may (or may not) know that all three of my kids were delivered by c-section. This fact isn't something I've ever felt the need to defend, or even discuss too much (especially with near-perfect strangers). But the snarking that happened the other day had two effects. First, it pissed me off a bit. Second, it made me realize that I wanted to write a bit about my experience (don't worry, no gory details!) and SAY JUSTICE to the man who delivered three of my highest values.

Let me just say a few things about c-sections before I begin saying my justice.

  • C-sections are certainly not natural in any sense of the word, and I think that where possible, a vaginal delivery is best for everyone involved.
  • I also think the c-section rate in this country, and especially Georgia (in part, due to the fact that we are not allowed by our legislature to have free-standing birth centers), is way too high.
  • I vehemently discourage anyone considering having a c-section just because they think it's easier somehow. It's not. I've heard of women who want to spare themselves hours of labor and the pain associated with that. I've never experienced real labor, but the pain and discomfort associated with healing after a c-section lasts for WEEKS, not hours or days. Just sayin'.
  • I support VBACs, including support and education to encourage women to try it and raise those VBAC rates. (VBAC is "vaginal birth after caesarean.")

Also, because of a couple of my previous "real" jobs, I'm intimately familiar with malpractice insurance, physician billing, and other health care goings-on in my state. Okay--got it? Good. (Also, I'm not a doctor, so don't take any of this as medical advice. I know YOU won't, but I always gotta worry about the FTC watching.)

Those things said, I am oh-so-thankful for c-sections! C-sections are WONDERFUL things. Yes, I said it: WONDERFUL.

And they are very safe. Not without risk, certainly, but this is the most commonly performed surgery in the country. It is safe, particularly a planned c-section. It's those emergency/urgent c-sections that are riskiest. But it's those are that are the most needed, so in those situations, it's worth that higher risk to the mother and the doctor.

Ryan was an urgent, unplanned c-section. Two weeks overdue and lodged up high inside me, he started showing signs of distress the second any kind of contractions began. Things quickly deteriorated, and in order to get him out quickly (he was stuck), the surgeon made a vertical cut after the first, horizontal cut. My doctor saved Ryan's life. After a few days in NICU (he had Meconium Aspiration Sydrome, and it was very, very bad at first--fortunately he rallied quickly), he was fine.

Because of the type of incision during Ryan's birth, I was not such a great candidate for a VBAC. I do think that if I had been in a more birth-friendly state (that is, not Georgia), it would have been easier to explore those options if I wanted to. As it is, and women who have given birth around here know this to be true, it's HARD to find any obstetrician willing to let a woman with my inverse-T incision undergo a VBAC. Yes, I could have found one if it had been important enough to me. As it happened, Morgan was in there sideways (and stuck). They didn't want to try a version (turning her from the outside, yuck) because of the previous c-section. Transverse breech is a hard indicator for a c-section anyway, and with my history, it was a no-brainer. Morgan's birth was much more relaxed than Ryan's, obviously. It was even fun and lighthearted in the OR.

With each subsequent c-section, it becomes riskier to have a VBAC, and therefore, more difficult to find a guy. I didn't even bother. I know! GASP! Given my history and situation, and the fact that planned c-sections (while not without risk!) are pretty safe procedures, I went ahead and had Sean that way, too. For whatever reason, and I never heard the full story about how this could have happened, this little baby decided to, what, turn at the last minute? Anyway, THIS is the kid born feet first. Crazy. (Not that you can't deliver a breech baby the regular way, I know!) I have never regretted for a second scheduling his surgery.

Because of my surgeon, all three of my babies landed safe and sound. Things were pretty dicey with Ryan there for a while, but he was fine because my surgeon knew what to do and did it. His skills and knowledge got us all through the surgeries safely. I have never second-guessed my decision to have the two repeat c-sections, and I am forever grateful that he knew what to do with Ryan.

So this is my Justice-Saying. Sure, kind of a strangely particular topic, but as I said--what happened the other day really got me thinking about my birth experiences and how grateful I am that my doctor studied hard and practiced a lot and used his brain and worked in a hospital with the latest technological equipment and knew just what to do to take care of us.

Dr. Michael Echemendia, I can never thank you enough!


Lynne said...

I'd like to add my thanks to Drs. Heller and Coffey, and especially to Dr. Peterson who performed the first c-section which was by far the most difficult for all of us. She kissed my forehead when it was over.

Rational Jenn said...

Lynne, awwwww. That's so sweet, kissing your forehead. One midwife stayed with me throughout Ryan's surgery, too, and it was such a comfort. Not how I thought she'd be helping me, but she stayed with me anyway.

I should also thank the midwives who attended Ryan's birth. They tried and tried to get me into a position where I could labor without Ryan's heart rate dropping dangerously. They tried for a few hours. But then they were worried and called the doc--which is just what they should have done. We just FLEW down the hallways--one of my main memories (I was slightly drugged).

And my doc, nearing the end of a 24 hour shift, delivered Ryan at 5:36am.

So yes, my midwives get props, too, and the anesthesiologist and the nurse anesthetists and the PA who assisted in Morgan's and Sean's surgeries (and his name is Bruce Wayne, for real! We joked that Batman was stitching me up!).

And all the nurses who took care of me, from pre-op where they do that yucky stuff to you (YOU know what I mean) and afterwards when they help you walk and remove your staples.

And the docs and nurses in NICU. Ryan was very sick for a couple of days, and yet, he was the largest, healthiest baby in the NICU. They taught us how to manage the wires and cords attached to him and still get to cuddle with him, too. They praised us for his burps.

And the lactation consultants who worked with us. I didn't get to nurse him until the next day. A whole day! And things were fine, but how sad I was about that.

Yes, they all deserve my thanks and gratitude, and they have it. And people who insist on snarking about c-section births can just stuff it. I have my babies. :o)

Heike said...

Jenn - I so agree with your post. I personally really wanted to have my babies vaginally, and was very distraught when we discovered a week prior to my first child's due date that she was breech. We did try a version (yuck is right - quite painful), without success - and had to have a 'planned' C-section the very next morning.

I was very upset - but, like you, very thankful after the fact that we live in this country, and that c-sections are a way out of what otherwise might be a deadly situation for child and/or mother. My c-section team, too, was very professional, and made even that experience an overall positive one.

Where I live, my hospital is very VBAC-friendly, to the point of offering VBAC classes to patients, and I was able with my second to have a VBAC. I would have been very upset indeed at any legislation that would have prevented me from having that choice, as recovery after a vaginal birth is better, esp. with having a toddler around.

I so agree with 'saying justice': after my C-section, I sent a long letter to my Dr. and birth team, thanking them for their efforts. My Dr. told me afterwards that it was very rare for her and her practice to get positive feedback of any kind, and especially after what was clearly not my dream birth experience. They do appreciate it if their hard work is honored - and I'd encourage everybody to let their health care providers know when they have done a good job, esp. in these days where the Man in Washington likes to disparage these very dedicated professionals...

jessicaanne010 said...

Hi Jenn, your post popped up on my Google Alert for Inverted T info. I totally understand your reasoning for having RCS (repeat c-section), it is scary and it is very hard to find a care provider that will assist a VBAC after an Inv T. I had an Inv T after a regular Low Transverse, my 2nd c-section was scheduled for breech. I just wanted to let you and your readers know that it is possible to have a VBAC after an Inv T, after searching for what felt like forever, I found home birth midwives in Michigan (I'm in Ohio) that assisted me. I've heard good things about Dr. Tate in Atlanta, and there are 2 docs in Texas that I know have assisted mom's with VBAc after Inv T. If you or any of your readers that have had an Inverted T, J or Classical cesarean are interested I have a yahoo group called Life After Inv T. Feel free to join us! Also, all of my birth stories and a few other women's VBAC after Inv T stories are here: Attempting a VBAC after an unusual incision type is scary and takes a lot of planning, finding the right care provider and all that. I never fault a momma for choosing what she thinks is best for her baby(ies).