Guest post by Susan Peterson
This is the second installment of Susan’s documentation of her births. Read Part 1: Giving Birth in 1973: Susan’s Story.
Baby #2, VBAC. Not triumphant, but a step in the right direction.
I was pregnant again when my first baby was 8 months old. I started looking for a doctor who would let me try to have the baby vaginally. At that time I hadn’t questioned that this was something a doctor could ‘let’ or ‘not let’ me do
I first went back to my original OB group, where I was given the standard lecture on the dangers of uterine rupture. I remember hearing “When we have a rupture most of the time we are past thinking about saving the baby, we are just trying to save the mother’s life, which usually involves removing the uterus.” I admit that this scared me. But if the prospect were so dismal, why had I read that doctors in Europe were no longer of this opinion? I went to at least one other medical group in Annapolis. When they heard what I wanted they didn’t even want to see me; they had their receptionist send me away. Then someone at La Leche League told me about this wonderful obstetrician in Washington DC, who did some homebirths, and if anyone would do this, he would. This was Dr. James Brew.
(There is a section by Dr. Brew, and pictures of him, in The Home Birth Book by Charlotte and Fred Ward, Inscape Books 1976.)
So I made an appointment with him. There was something of a problem with this as my husband and I did not own a car, nor did either of us drive. The public transportation between Annapolis and DC was not very convenient at that time, or else I was not aware of it. I begged a ride. I begged a ride for each visit. I thought Dr. Brew was wonderful. He told me that the rupture rate was 1% overall. He discussed statistics a bit. He talked about whether there were a way to distinguish who might fall into that 1% and who was less likely to, mentioning lack of infection in the surgical scar, good nutrition. He also told me that some small scar separations were only discovered after the birth and had not actually caused any problems with that birth. He told me, however, that I did have to realize that there was a risk. Catastrophic ruptures do occur, but he didn’t think their frequency was enough to justify the “Once a C-section always a C-section” rule. He assured me that even though I had an up and down cut on the outside, he was sure my uterus was cut low cervical, as this was the standard unless the C-section was an absolute emergency.
We discussed the circumstances of my C-section and while he said that I had been treated according to standard of care, he agreed, for instance, that if the pitocin was doing nothing, it wouldn’t have hurt to turn it up. I think he also told me about the study the 24 hour rule was based on, and what might be the drawbacks of the study.
I remember that I arranged with him that if I did have to have another C-section, they would set it up so I could watch in a mirror, since I had decided after some reflection that this would not be too disturbing for me. Husbands in the OR, however, were not on the list of possible options then, and I don’t think my husband was anxious to see me cut anyway. The last visit before I went into labor I asked Dr. Brew what sorts of things could result in my having another C-section. I wanted to be mentally prepared. He said, well, for instance, he had had one woman who had gotten to six centimeters and stayed there for hours and the feeling was that such a prolonged labor was too severe a test of the scar. I was aware to some degree that it was not only his feeling about this situation which was involved but that he was under a degree of scrutiny for his unusual practices and could only push things so far.
My due date was December 14. I went into labor on December 20th. Again, there was absolutely no worry or concern about being “overdue” conveyed to me. I can’t remember the beginnings of this labor in much detail, except that it began very gradually, with contractions 20 minutes apart. My entire concern was whether my body really would go into labor, since it never really had the last time. My first clear memory of the labor is of being in the camper type van belonging to one of my professors, being driven to the hospital. I had been told to go as soon as I knew I was in labor, as there was more concern to monitor a labor more closely after a C-section. But I didn’t really admit I was in labor until my contractions were down to about 5 minutes apart. I still was afraid I wasn’t; if a contraction were delayed to six minutes, fear still hit both me and my husband that all would stop. My professor was quite amused at this. “It’s a very logical time for this to be happening, you know,” he said. When we got to the hospital, Georgetown, we had no idea where to go. At one point we even went down a drive labeled “Deliveries.” When we saw people unloading trucks, we realized our mistake. Finally, I think, I went in through the ER. I must have had an enema and been shaved, because that was definitely hospital protocol at that point, and Dr. Brew writes in the book I mentioned above that he asked his home birth clients to have an enema as well (!) but I have to say that this has entirely disappeared from my mind. The next thing I remember is sitting in a labor room, in a bed with the head elevated and my legs stretched out in front of me, doing Lamaze breathing and staring at my Lamaze “focal point” a print of a Madonna and child painting in which a toddler Jesus is putting his hand down the front of Mary’s blouse, obviously wanting to nurse. I later taped this picture to my baby’s crib. I began to have some harder contractions, and at the end of one said “That was a rough one.” My husband said ‘Good’ and I slapped his arm with some serious annoyance. He kind of sulked for a while before getting over it. He was only glad I was really in labor, but I had accepted that a while back and felt that ‘Good’ was not the right response to what I was feeling!
Dr. Brew had come in to admit me, and had been in and out of the room a couple of times. I heard his voice and another male voice, in the hall. He then came in and said he had to go back to the office, and he was having a midwife come in and sit with me until he could do so himself. He said the hospital was putting some pressure on him to do electronic fetal monitoring, but that he had a good study which showed having someone listen with a fetoscope every 15 minutes had better outcomes than monitoring. I don’t think I realized quite how far he was sticking out his neck. Six months after that he lost his privileges at that hospital and I heard it was for refusing to fetal-monitor every patient. The nurse midwife was Marion McCartney, one of the two who had founded Maternity Center Associates (http://tinyurl.com/23nfg3w) a homebirth nurse midwife practice which they owned; Dr. Brew was actually their employee as their backup doctor. She was very nice, but mostly only did just that, listened to the baby’s heartbeat. All this time, I was sitting in the bed, doing Lamaze breathing through the contractions. She might have made one suggestion about my breathing. I look back on that scene and think, “Why didn’t she have me get up?” It was a fairly small room with, just a sink and toilet bathroom, no shower, but I could have walked from window to door. In fact, I wasn’t hooked to anything; why couldn’t my husband and I have walked in the hall? But no, there I was in the bed. At the time, nothing else occurred to me. The contractions were definitely, as they said in Lamaze class, ‘uncomfortable.’ I was definitely tensing up with each one. Dr. Brew came back, and Marion left. By that point I really didn’t want her to go; I had gotten attached to her as the person who was with me in the birth. She could tell this and apologized for being in the hospital for a scheduled shift and having to leave and go home to her family. I had a feeling afterwards that if she could have stayed, it might have gone better, although I am not sure what she would have done.
Dr. Brew examined me, and I was six centimeters. An hour later I was six centimeters. I am not sure how long I was six centimeters. He watched me through a contraction, said I was too tense, and that he was going to give me a paracervical block. I was nowhere near to the point where I would have asked for pain medication, but I wasn’t going to argue with him. I remembered that woman who got to six and no farther. If he thought this would work to get me dilated, well, I trusted him. So I had it. All the pain went away. I dozed for a while. It didn’t seem like long later that I was beginning to feel contractions again, and was told I was at 8 centimeters. It seems that it had worked. I was asked if I wanted another paracervical block. I asked if I could wait and see if I could handle it. They said no, the cervix was disappearing, pretty soon there wouldn’t be enough left to put the block into. I felt as if I had been in the calm eye of a storm and now felt the hurricane rapidly approaching. I thought, “Why should I hurt?” and said yes. I look upon that as my fatal mistake. As soon as they had given me the paracervical, (which was done by the OB himself, with a hugely long needle, through a narrow tube called a needle guide) my husband said, “You are cutting yourself off from all the experiences of women in labor , in literature, through the ages.” As soon as he said it, I knew he was right and I regretted it. I thought “You could have said that before I did it.”
Anyway, I got to fully dilated quickly, feeling nothing. Dr. Brew had me lie down for an exam. I could add that not being in pain, and not being particularly modest, I had no objections to these exams. But then he said I was complete, and said, “Try to push my hand out.” I had no urge to push. I have always thought it was because the paracervical had numbed the whole area. I gave an enormous head directed push while lying flat on my back. At that moment the baby flopped over inside me. At the same time, it looked as if snakes were swimming under the skin of my abdomen. The doctor and the nurse laughed out loud. I said “What’s happening? It can’t be too bad if you are laughing.” Dr. Brew said, “It isn’t too bad, but it means we are going right in the delivery room and have this baby. Your abdominal muscles split, and your intestines swam up in front of your uterus, that’s what you saw. You won’t be able to push this baby out. ” He said to the nurse, while feeling around inside and outside of me, “That baby flipped right over; it is posterior now, no doubt about it.” I pleaded, “Can’t I even try?” He repeated that I would not be able to do it with my muscles in that state. I asked if I would ever be able to push out a baby. He said, “Maybe if you have twins, they will come squirting out like little watermelon seeds.” He stepped back, and said, as if to someone behind him, “I guess this is all we will be able to get out of this one.” I think he may have been speaking to a medical student or intern; if so, I have no idea when he came in the room. I felt as if it were some kind of verdict on my birth, as if I had somehow failed.
So they told me they were going to deliver the baby with forceps. I was wheeled into the delivery room, had my legs put up in stirrups. They gave me another block, called a pudendal block. Dr. Brew actually said, “Where’s the mirror?” to the nurse, and to me “Didn’t you want to watch this? You wanted to watch even if you had a section.” And I said, yes, of course I did. They put up a mirror, pointed at my perineum. The doctor started to talk to the medical student/intern, explaining what he was going to do. I thought this was cool, because I could hear everything he said. When he did an episiotomy he mentioned the name of the kind of scissors, and my husband, probably resorting to humor because my being cut was not comfortable for him, said “You mean you don’t use Sabatier?” My husband was a chef, and Sabatier is a kind of French chef’s knife. But Dr. Brew was taken aback and at first thought he was really being criticized. Later I asked him how he thought a lay person would even begin to know enough to criticize what medical tools he used, and he said that made sense, but the reason a lot of doctors didn’t want husbands in the delivery room is that they were afraid of criticism.
So anyway, what they did was a mid-forceps rotation delivery, in which they put the forceps on once, turn the baby, take them out, put them in again and pull the baby out. I don’t believe this is ever done anymore; it is considered very risky. But I think Dr. Brew knew what he was doing. I just felt a lot of movement inside, and pressure. Then I have a very clear mental picture of this little red baby head sticking out from between my widely spread legs, the picture in the mirror. The head was crying! I know most babies can’t cry when just the head is out, and none of the rest of mine have, but this one was. My husband and I said, “He’s crying already!” We were the parents of a boy, we could only think of ourselves as the parents of a boy, and somehow expected another boy, although this is not at all logical. I am not sure what Dr. Brew did to deliver the shoulders; I don’t remember having any active part in it. In any case I was soon holding my baby girl. I remember crying out “Oh Chris, we have a little girl!” Dr. Brew was disappointed that we had a girl, because he had wanted to teach the medical student his dislike for circumcision. He wasn’t going to let the fact that we had a girl stop him. He said to me, “Now, if you had had a boy, you would not have him circumcised.” My husband must have thought this was a strange thing to say, because he responded with another joke. He said “As long as her heart is circumcised.” The medical student laughed, obviously having had a Biblical education at some point, but Dr. Brew was totally bewildered. ( Of course my husband was referring to St. Paul’s conflicts with those who wanted the early Christian converts to be circumcised, and Paul’s argument that what matters is that the heart, meaning the will and affections, is circumcised, meaning subject to God.)
Then, I remember Dr. Brew pulling on the cord and explaining to the student about “controlled cord traction,” and how it is a good thing. Maybe, but I bled plenty. The placenta was out 5 minutes after the baby, according to the records I saw later.
So then we were back in the labor room, and I was trying to nurse my new baby girl. She was alert, but I had trouble getting her interested in nursing. She had a bruise on one cheek from the forceps, and her face was kind of squashed, as if the top of her nose had overridden her forehead a bit. She wasn’t too pretty right then. My husband called her “Le petit crapeau” -the little toad. (Forgive my poor French spelling. He’s the one who knows French.) I am used to his comments, but I was a bit distressed about her face. The nurse assured me that this would all straighten out in a few days. And it did.
Then it was up to the room on the maternity floor, while the baby went to the nursery. As soon as we were there I got up, walked to the bathroom and peed. Definitely an improvement over recovering from a C-section, unable to walk and with a catheter. Later, a nurse came and asked me if I was able to “pass water”. I didn’t know what she was talking about. “Water” meant amniotic fluid to me, and surely there was none of that left? I finally grasped that she meant could I pee, and said yes, I already had. She seemed dubious, and wanted to see some pee, which I had already flushed. With all that pressure, I suddenly couldn’t pee at all, and for hours I couldn’t, even taking a shower to try to make myself pee. The power of suggestion!
They brought the baby back and told me she weighed 9’ 6 oz and was 20” long. She looked very short and fat. Then I had her in the room with me the rest of the night. She was born at 20 minutes to midnight. My husband slept in a chair next to us. This was definitely an improvement on the last time! After a while she did nurse, in a far more dilatory fashion than my vigorous son.
Fifteen hours later, we went home. First to the professor’s house, to pick up my son, who was watching TV with my professor’s two young sons, and seemed fine. My son, only 17 months old, seemed quite interested in the baby and to have a relatively positive reaction to her. Then came the moment when he saw me nurse her. The horrified, indignant, abandoned howl he let out cannot be believed. He hadn’t nursed for a couple of months, and had gone to drinking bottles, several a day of Adele Davis formula with brewers yeast in it, but apparently he still regarded those as his breasts. He went wild. He tried to drag her off my lap. He tried to attack her with a wooden toy block. My husband would have to be back to work the next day, so I would be alone with both of them. There was absolutely nothing for it but to nurse him also. So that is what I did. I didn’t like the feeling of nursing both at once; it was like having my emotional focus torn in two. As soon as I could, which I think took several months, I convinced him that he had to wait until she was done, and I didn’t mind at all nursing both of them but one at a time. But for several months he wanted to nurse whenever she nursed. He completely gave up the bottles. Since we only had a double bed, we pulled the mattress down on the floor, and I was sleeping there with the two babies, while my husband slept up on the box spring. I would have my infant girl on the lower breast, and my son would say ‘I want back breastie” and reach over from behind my back and nurse on the upper breast. I was completely absorbed in caring for these two little ones day and night. My husband worked six ten or eleven hour days a week in the restaurant, and came home exhausted. I am sure, too, that he felt quite neglected by me, although he never said so. For the first time in my life, I was quite uninterested in sex. For one thing, I was really torn up down there. The OB book said that there were two kinds of midforceps rotation delivery; one was hard on the baby, the other, the “Scanzoni rotation” which is the one I had according to my records, was very hard on the mother’s tissues. Sex hurt for six months. Dr. Brew just said, “I have heard that from other women also, but it doesn’t last forever.” I accepted this, and it didn’t. But it actually did take longer to recover from completely than my C-section.
This was not the triumphant VBAC that many talk about now, but I felt moderately satisfied with the outcome. I considered it a step in the right direction. I did pursue Dr. Brew with questions in his office. What if I had squatted? Suppose I had been all alone in a barn, would the baby just have never come out? He sighed and said that maybe in four or five hours the action of the uterus would have gotten the baby out without much assist from the muscles. I asked if that would have harmed the baby, taking so long to be born. He said that there had been discussion about this for a long time, prolonged second stage versus forceps deliveries, but it hadn’t been resolved and at the current time ‘they wouldn’t let me get away with letting you push that long even if I wanted to.”
Somewhere along in here I had started doing some more reading about birth. It wasn’t as easy back then to find out about books to read, with no internet. I usually found them at La Leche League meetings, or people there told me about them and lent me their copies. Before these first two births I think I had read things like “Thank you Dr. Lamaze,” Grantly Dick-Read’s “Natural Childbirth,” and “Natural Childbirth and the Christian Family.” But now I got my hands on Suzanne’s Arm’s “Immaculate Deception,” and on Ina Mae Gaskin’s “Spiritual Midwifery.” I was initially biased against both, because the title of the first was an unpleasant play on a doctrine of my religion, and the second was just too “hippy” for me, calling contractions rushes, talking about having babies in old school buses, and with background references to a guru like figure. Even the psychedelic cover made me uncomfortable. But by now I was desperate to understand what was clearly wrong with what had happened to me in my births, so I read them anyway, and they transformed my understanding. It was like a light going on. ID clearly described the hospital scene I had experienced, and Spiritual Midwifery gave an insight into the interior experience of birth and a vision of what it could be like. I started reading everything I could about birth. I went to a NAPSAC conference in Washington DC. I remember standing with David Stewart outside the convention center just before I left, and telling him about my hopes for a home birth. Here I was, a woman with a “bad” obstetrical history, one C-section and one mid-forceps rotation delivery, and I could tell that even he, the home birth advocate, did not really think much of my chances. I knew it looked that way. I didn’t believe it. I didn’t think that woman with the bad obstetrical history was really me.
I also met the author of “Essential Exercises for the Childbearing Year” at a conference, either the NAPSAC conference or a La Leche League conference, and we talked about the split in the abdominal muscles, diastasis recti. She took me into the ladies room and taught me an exercise to bring the muscles back together. I did it every time I thought about wanting really to give birth, which is to say, two or three times every day. I no longer had sexual fantasies-I had birth fantasies. Again I wished for floods or blizzards or the end of civilization, anything which would give me permission just to let my body work.
It took me a little bit longer to become pregnant again, nursing two babies as I was. But when I went to that NAPSAC conference I didn’t nurse for 24 hours (except briefly when a kind woman lent me her baby to relieve my engorgement) and two weeks later I ovulated for the first time and we started baby number three, whose story will follow.