Never mind, maybe next time

Reflections on a necessary caesarean

I had a positive caesarean birth experience. I had spent my life as a midwife supporting women to have the best birth possible and have always been a strong advocate for women aiming to achieve a natural birth.

Sadly, before we even started trying for a baby I experienced a botched procedure (medical negligence) which left me with very little in the way of a cervix although we didn’t know the extent of this when we found ourselves happily pregnant for the first time. We lost our first baby despite attempts by my wonderful Obstetric Consultant to save the pregnancy.

Once we were pregnant again I was referred to a Consultant in a different hospital who had a lot of expertise around preserving pregnancies under these circumstances. He assessed my cervix and advised me that there really was very little of it left. He was really supportive and even at this stage he gave me choices. He said that if I wished to try a Shirodkar suture to support my cervix he would attempt inserting one but his concern was that so little remained of my cervix that it wasn’t just about strength, it was also about being able to provide a barrier to infection. He gave me an alternative which was to undergo abdominal cervical cerclage which involved waiting until approximately 12 weeks of pregnancy and having my cervix stitched shut via abdominal incision. There were also risks involved with this procedure as the pregnancy could be lost due to the procedure but if successful I would be much less likely to lose the baby at a later gestation. This option would mean inevitable caesarean birth.

He really was amazing (Professor Philip Steer just for the record) and spent lots of time with me debating the various pros and cons for each option, he was really understanding about my head space (being a Midwife and natural birth advocate) and gave me plenty of time to discuss it with my partner. We came to our conclusion that we wanted to maximise our chances of having a live baby so opted for the abdominal cervical cerclage and caesarean birth.

Despite this it still took me some time to come to terms with my new reality. I come from a line of hardy country women who have never had a caesarean in their life and didn’t know how to respond, in fact that was probably the most difficult thing for me to navigate; how people responded. I came to realise that many people just put their foot in it without meaning to but also that some people are incredibly judgy!

I remember later in pregnancy I began thinking ahead and tried to arrange some postnatal support as at the time we lived in a quite a ‘nuclear’ situation far away from our respective families. Postnatal Doulas were a bit thin on the ground at that point, most of them focused mainly on birth. I rang one and explained that I needed postnatal support rather than birth support as I was having a caesarean birth and she said ‘never mind, maybe next time’. I explained that due to complications it was unlikely I would ever have another vaginal birth but would really appreciate some postnatal support with this baby as I was feeling a bit ‘far from home’. She said she would ring me back but never did. It was challenging to have this baby’s birth dismissed in favour of some other yet-to-be-conceived baby that would surely be born ‘properly’ or in a more acceptable manner. This wasn’t the only time I experienced feeling like this in my pregnancy. Ironically soon after my son was born my fertility plummeted quite dramatically and we never did have another child but I really understand how some women develop strong feelings of needing a ‘do-over-birth’ after a caesarean; it is a message drip fed to us that we can get it ‘right’ next time.

I needed to get my head in the right place before the abdominal cervical cerclage and in the end, I spent a night out under the stars with a campfire burning to give myself the space to really assimilate my feelings. Just like physiological birth, there is a dark before the dawn; when the sun has been gone for so long that the earth is chillingly cold to sit on, the cold gets into your bones and the ground saps the last of the warmth from your body and you start to wonder, just for a moment, if the sun will ever rise. But rise it did and with it rose my mood. It lifted with the sun as I realised that I felt grateful that despite what had had happened, I lived in a world where I could get access to an expert procedure (free at the point of care) that would ensure I had the best possible chance of holding a live baby in my arms.

I came to understand that when taking into account the births of the women in my family and my own deep faith in birth, that had things been different I would very likely have had a straight forward birth but what would that have taught me, really? As a Midwife, as a woman, as a mother? This experience would shape me into a very different Midwife to the one I would have been had this not happened (lets face it, I probably would have been a smug twat!)

My son and I became very connected; a team throughout all of this and I vowed to do all I could to bring him here safely, whatever ‘sacrifice’ that meant making. I just asked of him that he ‘hang on in there’ during the procedure at 12 weeks and I promised him, that while I couldn’t promise I would be the best mum in the world, I promised that we would have a lot of fun, that it was worth his while coming to earth just for the fun we would have.

The procedure went well and as we approached the birth I worked hard to stay focused on the positive aspects as having a whole pregnancy where you have to field other peoples judgement, pity and ‘sad’ faces is a little wearing.

We woke early at around 4 a.m. to make our way in a cab across London for the birth which was scheduled for first thing in the morning. It was beautifully surreal as we sat holding hands in the back of the taxi. In the blue morning light we saw the Queens guard trotting their whole stable of pure black horses along the deserted streets of central London. It felt really special.

We were quite glad that the birth was delayed. An emergency caesarean had to take priority and I was happy for whoever that mother was to be prioritised, I imagine she had had a very different night from mine and I held her in my thoughts that morning. The extra time gave David and I time to sit together and settle down a bit before walking to theatre together. The theatres are always kept cold but once I had had my spinal anaesthetic my blood pressure dropped a bit (it’s generally on the low side anyway) and I began to shake uncontrollably. The theatre staff were gorgeous and brought me an extra blanket for my shoulders while I lay down and they checked my BP. Once they had confirmed that the anaesthetic block was good enough using the cold spray we were ready for the drapes and the catheter.

I think the shakes were a combination of the obvious things but also the reality of me surrendering to the experience. I feel in control when on the ‘other side’ of a caesarean birth but in the role of the mother I had to learn to surrender and allow everyone to care for me; more life lessons!

We had chosen our music and David was in charge of that. The atmosphere was lovely and if we didn’t know better we could have been fooled into thinking we were the one and only couple having their baby in that theatre that day; we were made to feel so special.

The Prof was happy to have the drape as low as possible and talked me through the whole birth. I know we (Midwives) often talk about it feeling like someone is doing the washing up on the other side of the drape but I barely remember myself being moved around at all. I often think that this was due to having the drape lowered. I wasn’t disconnected from any movement I suppose; it wasn’t an abstract experience. My son (Reed) seemed determined to be born with his arm above his head and it kept popping out first with Prof trying to poke it back down to birth his head first. Eventually Reed got his way and was born Superman style to the sound of ‘Mr Big Stuff’ playing in the back ground (at the manly weight of 6lb2oz!).

Once I came to terms with how my son needed to be born it became a really positive experience. Any challenges for me, really were around other peoples responses to it. It’s really tough when we are bombarded constantly with the message that caesarean birth = inferior.

Nicola Nelson is a midwife and runs Way of the Koi Birth Workers, a facebook community of compassion focused, family centred Birth Workers. She is the author of The Easy Guide to Rebozo for Pregnancy and Birth.