Monday, December 7, 2009

Something to be Thankful For

I was intending to get a very nice post up prior Thanksgiving, listing all the things I was thankful for: my husband, Adam, who puts up with all my bad moods and stress when I put deadlines on myself; my four beautiful children, who also put up with my bad moods and stress; my few faithful friends, who have been patient and stuck by me as I've grown this business and have seemed to abandon the rest of the world; and Jesus, who loves me and forgives me, no matter how cranky and stressed I am. I am, indeed, thankful.

But then life happened, and I didn't get my post done. But I think the negative events that happened over my Thanksgiving week can maybe be used for the positive. I think. Bear with me, and please try to hear my heart in this.

My parents flew out here to visit us this Thanksgiving, a major milestone, as my parents hadn't even met our two youngest children. We anticipated a good time, maybe a bit awkward at first, as our kids didn't really know my parents, but good nonetheless. And then a "long lost" cousin joined us as well. Even better. I love Thanksgiving, I love the food, the atmosphere, and I especially love all my family and friends coming together in my home, the fellowship, and celebrating together. The day went well-- lots of good food, lots of good conversation, my kids were getting to know their grandparents-- all was well. We went to bed that night content and very, very full.

I was awakened a few hours later, just after midnight, by my dad, telling me that my mom was very sick and needed to go to the emergency room. I was confused-- what was going on? "She has another bowel obstruction," said my dad, "this is her fourth or fifth." What?! We quickly got dressed, packed up my mom, and rushed to the nearest emergency room, where she was, indeed, diagnosed with a bowel obstruction. She spent a few days in the hospital with a tube down her nose decompressing her GI tract, an IV in her arm for fluids and pain medications, and without any food, as she waited for the obstruction to either resolve itself, or have it resolved via surgery. Thankfully, it resolved itself.

A time for some of my mom's history, to shed a bit of light on her "medical history", if you will, and explain why she has had chronic bowel obstructions. My mom is 63-years-old, an age where one should be retired and enjoying the fruits of their earlier years, correct? You've heard the saying, "You reap what you sow"-- my mom, unfortunately, is reaping what her doctor's sowed into her life when she was only in her early twenties and having her children.

My mom got married in 1968, just before she turned 22-years-old. She was young, healthy, happy and full of life. A little over a year later, she was having "exploratory surgery," because she had complained to her OB-GYN that she had very heavy periods and bad cramping each month. Hardly grounds for surgery, but, as my mom says, "that's what they did in those days." Surprise, surprise, they found nothing during the surgery. She was normal-- many women have heavy periods and bad cramping each month when their cycles start, especially young women who've never given birth. (My mom's mother died when my mom was just 13-years-old, I don't think much of the normalcy of the female body was ever communicated to her as she was growing up, so my mom has always relied on her male physician's to tell her what is the correct course of action and whether something "is wrong" with her body, subject for another blog). Fast forward to November 1971, and my mom was in "the" birthing hospital in our area, in labor with yours truly.

As my mom tells it, she went to the hospital as soon as her water broke, which was basically the start of her labor. She was examined and then placed on a guerney, and my dad was sent home. Gotta love the early 70's, women in labor were the property of the doctor/hospital and they were "delivered" of their babies, no dads needed, thank you very much. It was roughly 10 o'clock in the morning. My mom would lay on this same guerney all day long, curled up on her side, having no knowledge of the normal course of labor and certainly no knowledge of how to give birth. She knew nothing about changing her position to alleviate her discomfort or aid birth, she knew nothing about eating and drinking to keep her strength up during labor, she knew nothing about remaining ambulatory (i.e., walking around) for as long as possible during the labor to help keep the labor moving, she knew nothing about having a support person with her during her labor to provide her with both emotional and physical support. My mother laid there on that guerney and relied on her male doctor to tell her what to do. And he told her to lay there and be quiet, don't make a scene. Oooh, a scene, my mom hated scenes. She details how she could hear the screams and yells of the other women in labor in the ward around her, and she remembers not wanting to be like that. "I'd be so embarrassed to make noises like that." So she laid there, silently. A little over 12 hours later, she was examined again, found to not have "progressed" (I'd love to be able to get my hands on her hospital admission record), and so she was taken for an XRAY. Yes, you've read this correctly. My mom was in active labor with me and she was given an XRAY to determine if there was "cephalopelvic disproportion."

I get sick to my stomach every time I think about this happening, XRAY'ing a pregnant women, exposing her delicate baby to nasty radiation. My mom gets angry each time she recounts this part of the story for a different reason-- "those nurses made me get up and walk to the XRAY room and here I was in labor! Can you imagine making a woman in labor walk around? It's just barbaric!" Clearly we have a difference of opinion.

I digress. The radiologist on call determined that, indeed, my teeny infant head was too large to pass through my mom's pelvic outlet. An emergency C-section, or cesarean section, was necessary. My mom was anesthetized, intubated, and I was roughly removed through the gaping hole in my mom's abdomen, sent to the nursery, and didn't get returned to my mom until almost three days later. So much for establishing bonding or even getting a snowball's shot at breastfeeding. My mom remembers that when I was returned to her, I "didn't like" to breastfeed, and since she thought the whole breastfeeding process was rather "disgusting" anyway, she was given a shot to dry up her milk and then was the end of it.

Almost three years later to the day, my mom was again in labor in the same hospital, this time with my sister. As my mom recounts it, she was angry again, this time because she had been given a due date sometime in the first week of December and she had been given a date for a scheduled C-section, and here she was in labor again almost three weeks early. She wanted to avoid labor and just have her surgery. Her doctor couldn't have been more happy to comply. Fast-forward another seven years, same hospital, and my mom was happily under the knife-- her third C-section, and, thank God she hadn't gone into labor before her scheduled surgery this time-- this time being delivered of my youngest sister. This time the doctor gave her news after the surgery that should have chilled her to the core-- he had had to remove quite a bit of scar tissue from my mom during her surgery. It was due to her first two C-sections, and it had wrapped around her intestine and appeared to have been adhering to her bladder as well. I don't think my mom ever understood what those words meant, nor do I think she attributed all the GI problems and abdominal pain that she had been having to it. All she cared was that he had tied her tubes and she was forever done with being pregnant and having babies, an activity she had never really enjoyed.

Fast-forward yet another seven years, it's now 1988, and my mom is again in the hospital, this time she's had to schedule surgery because she is having tremendous abdominal pain and bowel problems due to more scar tissue growth. Again, a direct result of the three "benign" C-sections. They must have been benign, harmless, normal, right? After all, depending upon which state you live in, anywhere between 35-45% of childbearing women are having C-sections. If it was dangerous or abnormal, your doctor wouldn't be carving young healthy women up like a Thanksgiving Day turkey, would he? Again, I digress.

Fast-forward again, this time to about 1993 or so. My mom is again having surgery, what we in the medical field refer to as a "LOA" or "lysis of adhesions," AKA removal of yet more scar tissue resulting from her three C-sections. This time I'm driving her down for the surgery, and I'm working at the hospital where she's having the surgery, as I'm finishing up nursing school. Even at this point I don't think it occurred to me that there was something terribly wrong with this picture. I don't think I understood the connection between all the pain and GI problems that my mom was having and her previous C-sections. This time the doctor informed her that the scar tissue had wrapped itself around her intestine and had attached itself to her bladder and was clearly working hard to take over her entire abdominal cavity.

This is really the first time that my mom had surgery where I can remember the events leading up to it and her recovery afterwards. I remember the intense pain she would have for months and months at a time, her lying in bed, curled up on her side, as I imagine she did when she was in labor with me. The pain would be worse when she had her menses as I recall. I remember her doctor calling in prescriptions for pain pills, telling her to just "deal with it," as he did when she was in labor with me. I remember her, foolishly, listening to him, afraid to complain about the pain, afraid "to make noise," as she has always called it. I remember finally even her doctor caving in and saying she needed surgery yet again if her GI problems and pain were ever to be resolved. And then I vividly remember her coming out of surgery, screaming in pain, thrashing about, and then just crying for hours after the anesthesia had worn off and she was back in her hospital bed. She would finally get sent home, where she would limp around for weeks as she attempted to take care of the house and her family, no one to help her, again, reminiscent of her recovery times after she had had her three C-sections.

I also have vivid memories of being with many women in labor while I was in nursing school doing my "labor and delivery" rotation (notice the "delivery" part of that-- women don't give birth, they are delivered, of their infants, a total reliance on their physician being more than implied). I was always excited when a "delivery" turned into a C-section and I got to go to the OR. I loved the OR, I loved the excitement of an emergent "delivery," right down to the blue, limp, apparently lifeless babies that were shoved up and out of the birth canal, back into the abdominal part of the uterus, and then to where they were "rescued" by the heroic OB who had quickly and effortlessly slit open the baby's mother to "save" them from imminent danger. It was amazing. I loved it. I had no concept of what contributed to all those C-sections or to the dangers the babies faced from having been put through that or to the long-term consequences of those C-sections on both the mothers and their babies.

Fast-forward now to 2002. I am almost 31, and pregnant with MY first child.
My middle sister had had a C-section a few years back (she will go on to have two more), and my youngest sister will have one herself a few years later. At this point I am beginning to think differently about this whole pregnancy and birth "thing." I have chosen a midwife to provide me with my prenatal care and to "deliver" my baby. I am blessed to be living in an area that has a birthing center available to me for the birth of my oldest child. During one of my first prenatal visits, I gave our midwife my family history--the obstetric history of my closest female relatives, including my mom and my sister and their history of C-sections. I told my midwife that I wanted a "natural birth," not just a vaginal birth, but one devoid of having been induced, drugged, or medically compromised in any way. She kind of snorted, told me that based on the mere fact that both my mom and my sister had had C-sections, I would "probably" require one as well, but then begrudgingly suggested that my husband and I take a Bradley Childbirth class if we "really" wanted to do this. (In hindsight, I think she told us to take the Bradley class in an attempt to scare us away from the idea of a natural childbirth, because as the months went on and we grew more and more in love with the Bradley classes, our midwife got more and more frustrated with our desire to have a natural childbirth.)

I have much to be thankful for, as those Bradley classes "saved my life" as it were. Honestly, we took the Bradley classes for my husband. I'm a nurse, I really believed that I knew all that I needed to know about pregnancy, birth, and breastfeeding. I thought my husband would benefit from the childbirth classes, as he will quickly tell anyone who's listening that he's "not medical" and has knows nothing about anything "medical." What I didn't know at that point in my life is that childbirth ISN'T medical. It's normal, it's healthy, it's not a deviation from health in a woman's life cycle. A C-section, on the other hand, IS medical (actually it's surgical), and it is a deviation from health in a woman's life cycle. I cannot even begin to detail how much I learned about the normal course of pregnancy, labor, and birth-- I would take the class again if I could, and recommend it for any pregnant couple, regardless of how they think they want to give birth.

I prepared diligently for my natural childbirth, unafraid of any potential pain or discomfort, and waited patiently for "my day to come." On December 29th, 2002, at 4:30 a.m., I, too, started my labor just as my mother and my sister had, with waters breaking and waking me out of a sound sleep. Unlike my mother and my sister, I did not immediately rush off to the hospital, although my labor intensified and progressed so quickly that I soon was at the hospital-based birth center, being told I was dilated to 8 cm already and would soon be pushing. I looked forward to it with happy anticipation. I was up for the challenge!

What I didn't know was that I would quickly progress to 10 cm, begin the second stage of labor (the "pushing stage"), and that I would push futilely for four solid hours. I kept feeling like something was wrong, and told the midwife so, but she brushed it off and told me everything was fine. I was exhausted, dehydrated (I had spent most of my labor vomiting), and felt I couldn't push anymore. The midwife told me that our son hadn't budged one bit in all those hours of pushing, but that since he wasn't in distress, I could either elect to push for another hour at which point I would have a C-section if he still wasn't out, or if our son went into distress he would be emergently "sectioned." I didn't like either of those options; nobody had prepared me for this possibility, the whole "done-everything-right-now-going-nowhere-and-no-good-options" stage. I tried to think clearly and have a rational conversation with my husband at this point, but let's be real, any woman who's been in active labor for almost 10 hours, four hours of which were spent grunting and pushing, will agree that there isn't much rational thinking and objective planning that can be done at that point. There had to be another option. I wracked my brains, trying to remember all that we had learned in our Bradley classes. What about suction? Could we transition out of the birth center, into the hospital labor and delivery unit, and have the OB come in and use suction to get our baby out? The midwife agreed that this was a possibility, but she cautioned me that I would be forced to received IV pain med (Nubain) as the doctor wouldn't agree to use the suction without it. I was torn; I had worked so hard to avoid any medications up to this point, as I was trying to protect my baby. But I also knew I didn't have the physical or emotional energy to push for another hour, only to find out that they wanted to do a C-section. I was adamant about one thing-- I WAS NOT having a C-section! I agreed to the drug, only a half dose, and off we went.

It was crazy how things progressed at that point. I was whisked to the labor and delivery unit, where I was transferred into a labor bed complete with the drop-down bottom, an IV was started and the Nubain given (to tell you the truth I was kind of looking forward to the drug at that point because I was so exhausted and in so much pain). The OB arrived, I was given an episiotomy (against my wishes but the OB stated she "had to" in order to use the suction, I found out later this is not true), and the work of "delivering" me of my son was begun. My husband still gets outraged when he recounts how he remembers it all happening. Here's what I remember: the doctor couldn't get my baby out, either. He was lodged in there, stuck, for some reason (a good vaginal exam should have given them the answer as to why he was "stuck," but clearly that wasn't done, I was instead, in need of "delivery"), and while not in distress, still needed to be extricated (the idea of using the Jaws of Life were at this point crossing my mind). The OB tried and tried to draw him downwards using "just" the suction. He still didn't budge. She finally brought out "the big guns": she commanded a large (mean) nurse to lay across the upper part of my abdomen and use all of her body weight and strength to push my son down from above, she herself reached her hand up inside of me and physically grabbed ahold of my son with her hand, she commanded someone else to utilize the suction, and then she ordered me to "PUSH!!!!!" I have never in my entire life experienced pain that intense or torturous, and I hope to never experience anything like that ever again. My son was "delivered," finally-- and I avoided the "inevitable" C-section. What my son and I later suffered as a result of all that is yet another subject for yet another blog.

But I am thankful. I have not had any C-sections. I went on to have three more births, none of which were anything like my first one. I learned after the birth of our oldest daughter, our second born, that the right side of my pelvis is angled inward. Most likely why during my labor with my son neither he nor I seemed to be progressing during the second stage (ie, why I did so much pushing without any progress). A chiropractor quickly took care of that problem, and I've never had a problem since. It's probably the reason why both my mother and both of my sisters have ended up having C-sections. It might account for the diagnosis my mom received when she was in labor with me, "cephalopelvic disproportion" (or CPD), which, incidentally, is exceptionally rare. (My mom didn't really have CPD, most women who are told they do, don't).

Back to my mom and her bowel obstructions. As my mom left to go back home after her Thanksgiving hospital stay, she grabbed my arm and said, "Oh, Tiff, make sure you don't end up like this. You don't want to go through this like I have all my life." I assured that I wouldn't, at least not for the same reasons that she has. I tear up as I write this, because my mom shouldn't have had to go through this, either. And I hope and pray that my sisters don't, either.

And I am thankful.

To learn more about C-sections, the complications arising from them, the possibility of a VBAC (vaginal birth after cesarean), and how to minimize the possibility of the actual need for a C-section, simply click on the title of this blog to be taken to the International Cesarean Awareness Network website.

1 comment:

Anonymous said...
This comment has been removed by a blog administrator.