The Birth of Otto: A Repeat Cesarean Story

She was pregnant with her second baby when she reached out for doula support. Her first birth had ended in a cesarean after laboring for many hours via induction with no cervical change. A vaginal birth after cesarean (VBAC) was her goal this pregnancy. She knew she could do it.

She spent pregnancy building a relationship with a care provider who said she supported VBACs. She worked on her nutrition and movement practices. She pursued chiropractic care. And, she did the incredibly hard emotiona work of learning to believe in herself and trust her intuition.

Her due date came and went. Finally, around 41 weeks contractions started. She rested at home, and stayed nourished. They came and went throughout a couple days and nights. An induction was scheduled for 41+2. She showed up for her induction, and it began with a cook catheter. She rested/labored through the night with the cook catheter. In the morning, she'd made some progress. Pitocin was started. Her water began leaking on it's own. She labored all around the hospital room with her husband and mom as support. Everyone was in such great spirits because progress was happening, slowly but surely. Early afternoon, contractions began growing in intensity, so they asked me to join them.

I arrived, and she was laboring beautifully. She moved through many different positions on the bed, used nitrous oxide, the tens unit, and a heat pack for comfort. She was tired, but we all had moments of smiling through the process.

A few hours later, her midwife came into the room and things shifted. The midwife brought an energy that was filled with disappointment at the progress that was made, and pressure around wanting labor to progress in a certain way. She spoke in a very curt manner. She wanted to place an internal monitor to measure the strength of contractions. We advocated for some time. The positive energy in the room had been broken. Everything felt unbelievably hard, and the words spoken by this midwife felt so wrong, controlling, and coercive.

My client cried, and her husband reassured her. We talked about what it could look like to fight for the labor and birth she wanted. We talked about how wrong it is that she had to fight at all, that the sense of safety and support was take from her because of the words of this midwife. She decided to go ahead and have the internal monitor placed. Shortly after this, she decided to get an epidural. Hopefully she could rest while her body labored.

Well into the evening, the epidural was placed. Her blood pressure dropped. She felt sick. Baby didn't like the change. Pitocin was turned off and her blood pressure was treated. It all felt a little scary and uncertain. Gradually, she started to feel better, baby recovered, and they both were given a short period of time to rest.

The midwife turned pitocin back on to the level it was at, but wasn't able to keep it on for very long because the baby was showing signs of not tolerating that dose of pitocin well. The midwife said she wanted to see cervical change by 9:30pm. She did a cervical exam, said there was no change, and said "I think it's time we have a baby." In other words, the midwife was recommending a repeat cesarean. My client gave a small nod. The midwife left to call the OB. My client, her husband, and myself talked amongst ourselves about their options- to wait or to move forward with the cesarean. She just wanted her baby to be here.

In labor, the person giving birth is in such a vulnerable state, both physically and emotionally. Anyone who does not respect this state of vulnerability, does not belong in the birth space. The way this midwife interacted with my client and approached the birth space stole the safety, trust, intuition, and peace my client had worked so hard to create.

We made our way back to the OR.

We made our way to the operating room. I waited outside the OR doors with the husband, while they got my client situated. We were then invited into the OR, and the surgery began. My client felt shaky, nauseous, and out of it through the whole surgery. The anesthesia team was very supportive and attentive, even offering to rub my clients shoulders because she was feeling so tense.

The surgery went smoothly, though it did take a bit longer because the OB and midwife needed to work through some previous scar tissue from the primary cesarean. Baby boy came out chunky and crying. He went to the warmer for a few minutes, and dad got to trim the cord over there. We had advocated for my client to do skin to skin, but she was feeling too sick and uncomfortable to do it. So, dad held baby right next to her. The midwife assisted with the surgery, and left during the final phases of the repair portion of the surgery. My client never saw her again during her hospital stay.

We moved back to her room where she would stay for recovery and postpartum. Fortunately, she was beginning to feel better by then. Baby latched on and nursed/snuggled very contentedly.

I believe my client was pushed into an unnecessary cesarean by her trusted care provider. I think this was a bait and switch situation- where a provider encourages and supports a person's hopes prenatally, but then totally changes opinion in labor.

I wonder how this birth might have unfolded in the care of a truly VBAC-supportive provider.

I am so proud of my client, her husband, and their baby for the love and resiliency they brought to their birth.