21 October 2011

From a Perfect Normal Birth to a Caesarian, in just a Few Simple Steps!

This posting is a follow-up on my posting Are We Still Designed To Give Birth Naturally? It is not intended to frighten anyone, but to help you make a balanced, informed decision based on the risks or benefits.
My second and third pregnancies both ended in miscarriages due to candida infections. By then we where wholeheartedly moving into a natural health direction because of our son’s health problems when he was 15 months old. We have moved from Bloemfontein to Cape Town and I had to get a new gynecologist.  With both miscarriages my Durbanville gynecologist and his partner informed me there was no way they could prevent the miscarriages due to candida. We decided to try natural remedies to heal me from candida and visited my homeopath.  Within weeks after I started the natural treatment for candida, I was healed, pregnant and dreaming of the possibility that my baby could be a little girl.  Needless to say I also changed gynecologists and I was now with my third gynecologist.
This pregnancy went just as well as my first pregnancy. 

We still had a few ultrasounds, but not with every six week’s follow-up. Except for being adamant to give birth naturally without an induction (50 - 60% of mothers being induced ends up with emergency caesarians) or epidural (taking in account my experience with CJ’s birth), we again didn’t have much of a birth plan.
Ten days before my due date I had a show around midmorning.  I was overjoyed and scared!  With CJ, my waters started to leak just after the show and he was born hours later.  Did this mean I would soon hold my baby in my arms?  I was not sure if I was ready yet, a few things still need to be done. Fortunately my hospital bag was packed and ready.  We called the gynecologist and he advised us to come see him in his rooms, and be ready to be hospitalized just in case I was in labour. 
I remembered saying goodbye to my little boy and almost burst into tears.  I didn’t know what to expect and didn’t know what to tell him.  What was going to happen until I see him again? 
At the gynecologist’s rooms the nurse immediately ushered me through to one of his examination rooms and had to wait for him.  Minutes later he walked into the room, asked me to lay on the examination bed. 

He immediately checked my blood pressure and next baby’s heartbeat.  Baby’s heartbeat was perfectly well, but my blood pressure was above normal.  The high blood pressure was strange, since my blood pressure was extremely low through out the pregnancy,.
What happened next I could only explain as a whirl wind.  Before even asking me anything or discussing possibilities, the gynecologist called the maternity ward and inform them Mrs. Lues was on her way for admission.  Only then he turned to us and informed us the high blood pressure is a high risk pregnancy condition, due to the possibility of preeclampsia and I needed to be hospitalized, immediately.
He didn’t test my urine for protein, or even question me for related symptoms of preeclampsia, like headaches, vision problems or swelling of hands or feet (of which I had none!).  I tried asking him if my high blood pressure wasn’t due to the test performed immediately after I laid down or my excitement but he didn’t even notice me asking... I remember from my gynecologist in Bloemfontein, a fine older gentleman, that I had to be laying down for at least 5 min before he did a blood pressure test,  On top of it, I was so excited and afraid of the possibility that I’m in labour, that obviously my blood pressure was going to be higher than normal!
No, he just rambled on about the dangers of preeclampsia and there was no way he was going to take any chances! 
Within half an hour I was in the maternity ward, in a public room with three other ladies.  I wasn’t sure what to expect next. My gynecologist, didn’t have the time for more discussions or questions asked, his next patient was waiting and he would see me during his hospital rounds later the evening. We had no idea what his plan of action was. On his 19h00 round he informed me that he was going to induce labour around midnight, by way of a vaginal induction gel - Cervadil Slow Release Pessary. Due to our lack of knowledge we had nothing to say, than accept it. Only years later I learned one of the side effects of Cervadil is Stillbirth!!  That is apart from the additional risks associated with induction. To what could be a perfectly normal birth, induction greatly increases the likelihood of further interventions, from pain relief to emergency Caesareans.
Christo intended to stay with me the whole night, but I sent him home by 22h00, to go get some rest.  He promised to be back by 04h00, when the contractions was supposed to pick up.  At midnight the nurse inserted the gel and I just went back to “sleep” - in the midst of routine noises every now and then.
By 04h00 Christo was back, but I had no contractions what so ever!  Five O’clock a nurse came and informed me, they need to insert a higher dose of Cervadil, this time through a pill.  See the pattern of more intervention...?   They also planned to move me to the labour room, since I would be giving birth soon.  Excuse me, I’m not even having contractions!?
An hour later I was in the spacious, bright, impressively equipped labour room.  They proudly showed me the private toilet on the side and showed Christo how to operate the TV hanging from the ceiling  I must have fallen in a very deep sleep, when the next moment I was awaken by the loud voice of my gynecologist who burst into the labour room and asked me how I was doing.  I still had no contractions at all, on which my gynecologist quickly made the decision (not even asking our opinion) to break my waters, in an attempt to speed up labour! 
It was only with my 4th pregnancy that we learned the great danger of Artificial Rapture Of Membranes (AROM).
Did you know: 

  • It is off the utmost importance that the baby is in a good position before the membranes are ruptured – if the baby is too high, there is a risk of cord prolapse, where the baby’s umbilical cord slips through the cervix before the baby, putting pressure on the cord. This can be a very serious situation as the baby’s blood and oxygen supply becomes compromised. Baby go into stress, labour progress to slow, next an emergency caesarian, due to the AROM.
  • Early rupturing of the membranes can result in more posterior or incorrectly-positioned babies. Again you end with an emergency Caesarian.
  • If your waters are broken before 4cm dilation, there is the possibility it may slow down your labour, or even have NO effect on labour. Now keep in mind when your membranes are raptured and you do not deliver within 4 - 24 hours (depending on the policy of the hospital or gynecologist) you would need to start antibiotics to prevent infection, since the seal around baby is no longer there to prevent bacteria reaching baby.  This is usually done by injection or possibly a drip (preventing you from being in active birth, cannot move around as easily). It’s best to avoid the need for antibiotics in the first place. Antibiotics not only kill the bad bacteria in your body, but the good bacteria too – they don’t discriminate. It can throw yours and your baby’s gut bacteria out of balance and often result in a colic or constipated baby.
  • After the AROM you are only given a short time frame for contractions to establish – sometimes only an hour or two – before being put on an IV (intravenous) Oxytocin (induction-drug) drip.  The IV induction will result in contraction waves occurring almost on top of each other, and increase in the resting tone of the uterus. This may be followed by you requesting pain relief, which may result in help by way of an instrumental delivery or caesarian.  All this is called a ‘cascade of intervention’ where one intervention leads to another and another and so on.
  • The hyper-stimulation (overstimulation) of the uterus, during induction, can deprive the baby of the necessary supplies of blood and oxygen, and so produce abnormal FHR (fetal heart rate) patterns, fetal distress (leading to cesarean section) and even uterine rupture.
  • Mothers induced with synthetic Oxytocin have a higher risk of significant bleeding after the birth. The numbers of Oxytocin receptors in the labouring woman’s uterus decreases, so her uterus becomes unresponsive to the post-partum Oxytocin peak that prevents bleeding;
  • 50 to 60% of mothers being induced end up with emergency Caesareans. Not only do you need the labour hormone, Oxytocin,  to be circulating in your body, but your uterus also needs Oxytocin receptors to be activated, something that only happens once labour is established, which takes time. Because your body may not be ready for labour, high amounts of artificial Oxytocin may be needed to get labour going and then it can still end in a ‘failed induction’ followed by an emergency Caesarean.  
Not a single one of the points mentioned above were ever discussed by my gynecologist as a possibility during my pre-natal visits, neither at this point of labour.

Seconds later, while I was still trying to clear my brain, after the very deep hour of sleep, I experienced the most shocking discomfort and pain I could imagine! They artificially raptured my membranes! 
Next my Gynecologist marched out of the room, shouting over his shoulder that he would see me lunch time, if I was not in the final stage of labour before then. Lunch was only 5 hours away, I wasn’t experiencing any contractions and couldn’t picture myself having a baby before lunch!  But then, right out of the “Induction textbook”, the hospital personnel was preparing me for an intravenous induction.  They will make sure I’m delivering my baby within hours, using all the possible interventions they possibly had at their disposal - sadly to my baby and my own increased risk!  Graciously (?) I had no knowledge of the above risks and I was in no position or had the courage to argue or question.  I was in the process now and was only hoping for the best!  Sad to say I don’t think I even prayed, but God was faithful! 
Within 2 hours contractions was ripping through my body! (#4 from the above) I couldn’t believe it happened again!  I was so determined not to allow all the different interventions. Now I know, I didn’t have a clue how vulnerable one is when you hand over the decision making to someone else!   
By 10h30 the contractions was so intense, I couldn’t bear it any longer.  I couldn’t focus on the contractions in the spacious, bright room and mentally experienced an overwhelming feeling of defeat, which in no way gave me the courage to stay on top of the contractions and let my body go with the flow. I couldn’t even try to walk the aisle, as I intended to do. I was stuck in bed, with  tubes of IV drips and fetal monitor wires - the Cascade of intervention!
The only thing I could think of was, “How long?” and asked the nurse to check my dilation. I was 5cm... only halfway. There was no way I could bear the pain for another 5 hours and asked for an epidural…  After 8 labours I’m convinced that with no other birth did I ever experience such intense contractions, one over the other. 
By 11h00 the anesthetist was next to my bed ready to perform the epidural.  He told me to sit up straight, my legs hanging from the bed and my back in a curve, and to keep dead still for the procedure. I had to warn him every time I felt a contraction coming. Since my pain threshold was at an all time low, by now, I almost cried while he gave me the epidural, due to the uncomfortable position I had to be in for at least 5 minutes! I only held on to the thought that the pain would be gone! 
Moments later a miracle took place, and I will praise the Lord forever for His intervention.  About 5 minutes after I moved back into a horizontal position, I realized the pain wasn’t gone, but bearable. The left side of my body was totally numb, but I could feel everything on my right side.  It was an amazing feeling, to feel the pain but to be on top of it. I was able to monitor my body, the contractions and labour myself, not by a monitor or third party!  
I was to afraid to tell anyone, in the fear they would turn up the epidural drip, and just hung in there, now at least able to work with each contraction.  But while I was still getting back to reality, I suddenly felt the strong urge to push. This was about 15 minutes after the epidural had been performed. It was an awesome feeling. My body immediately knew what to do. In total awe I realized, I’m at the point of giving birth and although up to now, everything went totally the opposite way I was hoping for this birth, I would be able to give birth without instruments, the way it is intend to be!  

My biggest challenge was to calmly ask the nurse to check my progress, without giving away that my body was not totally numb by the epidural.  I was so afraid they will turn up the infusion, and I would lose the feeling I still had in half of my body! The nurse was reluctant at first, since she checked me 45 minutes ago, but I insisted with a renewed strength, quickened by the turn in circumstances. What joy when the nurse with shock, and little panic, announced me fully dilated and ready to give birth. She informed me to hold back since they need my gynecologist.  There was no way I intended to hold back!  I urged them to hurry, and within minutes they had everything ready. Five minutes later, as my gynecologist walked into the room,, I prepared to give birth!  Waiting for the contraction and with it the urge to push! Within a few pushes, our little baby girl, Heidi-Mari was born, with no instruments!  

What a miracle! Taking into account all the procedures done 24 hours before Heidi-Mari’s birth, the diagnosis of ‘false’ high blood pressure, premature induction, premature breaking of my waters, “ten days prior to my due date”, it is only by God’s intervention that labour did speed up with the artificial Oxytocin infusion.  If the labour did not speed up, the next port of call would have be an emergency caesarean section - all totally unnecessary! 
Over the years the motivation for inductions became cloudy. An induction has only one advantage. When given for true medical reasons. It may ‘potentially’ save the life of a mother and / or her baby. Of course, if it leads to saving a life, we are all going to choose to induce – there is no argument that an induction would then be the best choice. Just like a Caesarean, it has a place in life-threatening situations – and for that we are more than grateful.
However, and this is were the statistics for caesarians in South Africa proof the facts, when an induction is performed for social reasons and convenience or without clear proven evidence cited by your Doctor, I encourage you to seriously think twice. 
I don’t mean evidence such as:

1.    ‘Well you’re 10-days overdue, we should book you in for an induction now, because babies could die if they are anymore overdue.’ 
‘Post-dates’ is the most common ‘indication’ for an induction.
Dear Mother, a full-term pregnancy is defined as 37 to 42 weeks. But this is a fact more and more overlooked by the gynecology profession. How can I be so sure that a full-term pregnancy can be as early as 37 weeks or as far as 42 weeks?

  • The estimated due date you are given is only a ‘guess’ in the middle of that.
  • We know that estimated due dates are inaccurate, due to the myth that every woman has a 28 day cycle and that every woman ovulates on day 14. Only about 10 to 13% of women ovulate on day 14. The day of ovulation differs from woman to woman and can even be different from month to month for the same woman.  Many woman will tell you they don’t have a 28 day cycle, some have a 21 day cycle and others a 32 day cycle.
  • Ultrasounds are notoriously inaccurate for pinpointing the day of birth (around 3% to 5% of babies are born on their predicted dates). Ultrasounds are plus or minus 7 to 10 days either side of the estimated due dates. This results from calculating these dates based on mathematics and averages, not your baby and the unique rate at which he or she grows or your unique cycle. Even first-trimester ultrasound can be inaccurate by 5 days either way.
  • Only 3% to 5% of babies are born on their ‘predicted date’ and full term is classed as up to 42 weeks of pregnancy, so for your baby to be born safely when he should be, when he is ready, you need solid supporting evidence that things are not safe to continue before intervening.
2.    False Blood Pressure
  • I totally agree that no one want to play around with a pregnant woman with high blood pressure.  But please make sure you do have high blood pressure.  
  • High blood pressure don’t just happen overnight, there is accompanying symptoms like:
  • Persistent headaches;
  • Changes in vision, including blurred vision, flashing lights, sensitivity to light and vision loss;
  • Upper abdominal pain, usually on the right side;
  • Sudden weight gain, typically more than 5 pounds (2.3 kilograms) a week.
  • Very important to make sure the pregnant mothers is resting for at least 3-5 minutes in the position the blood pressure is going to be done and don’t talk! How often I hear of mothers wrongly diagnosed with high blood pressure due to their excitement, anxiety or wrong position.  If you don’t have the above symptoms of high blood pressure, please ask that it be taken again after an hour, while you rest and calm down.  Your gynecologist might be upset with your request but so much depends on the results of this measurement.
3.    Progress of Labour is not satisfactory to the Gynecologist, Care-Taker of Hospital personal.
  • Anxiety or stress in the mother result in the slow onset of labour. You need high amounts of Oxytocin in labour and adrenaline is not helpful to Oxytocin production. Imagine a set of scales – as adrenaline goes up, the Oxytocin goes down. 
  • When you have low adrenaline, the Oxytocin can go right on up and get that labour going.
  • You might be familiar with the ‘flight or fight’ response we as humans have. If we feel anxious, unsafe or afraid, our body produces adrenaline, which pumps blood out to our limbs ready for escape or action. This means the response prevents more blood going to important locations for labour, including the uterus. Labour just shuts off or slows. In ‘flight or fight mode’, we don’t want our babies to come until we are in a safe place so we can ‘let go’.
  • Pressure from your gynecologist to go into labour before the ‘due date’ is by no means a safe place to get labour going. 
How Do I Know If I Need to Be induced?

If you are offered an induction and the situation is not life threatening, always ask the following questions:

  • What are the BENEFITS? (of this being done)
  • What are the RISKS?
  • Are there ALTERNATIVES? (other than this being done)
  • Does it need to be done NOW?
  • Can we have some privacy to make a DECISION?
Dear Mother, as you can see, something so simple as an induction can result in a whole heap of complicated stuff, so quickly.  Make sure of the facts before you give in to an induction!
With much love


Anonymous said...

“Sjoe, Linnie, ek is SO bitter, bitter jammer dat ek nie hierdie inligting 4 jaar gelede gehad het nie...Ek ken egter 'n paar eerste-keer-mammas wat binne die volgende paar maande kraam en sal hul almal reguit na jou twee blog artikels toe stuur en hul hopelik sodoende n klomp pyn en terleurstelling spaar.'”

Anonymous said...

“Ek voel nes Grietjie... maak my eintlik hartseer om nou sulke goed te lees, en die vele ander. Ongelukkig bly ons in 'n land waar dokters nie maklik na 'n keiser, 'n normale geboorte doen nie. So ek sit heel mootlik met verewige keisers... wil sommer huil. ai tog”

Linnie said...

Don't despair, look out for my next posting on VBAC's!

Anonymous said...

Goodness Linnie, I had no idea that candida could cause a miscarriage! We lost one baby to a miscarriage, and never did find out why he died... I have had systemic candida on and off for years... perhaps that was one question my Gyne did not ask himself? I am sorry you have had to go through such trauma in birth - my heart breaks when I read about these things, and I hope many women that read blogs and stories like yours and other mothers who have had to go through things like this, will take the advice and experience of others to heart and empower themselves with the right information that will give them courage to take back what was naturally always thiers!

Tanya said...

Linnie......It is a sheer miracle for a first time mom to deliver naturally in our private hospital system. My heart bleeds for young pregnant moms who want to do everything naturally, but are with a Gynae. You don't stand a chance nowadays. You are honestly the exception to the rule if you achieve natural birth in a hospital with a gynae. Something has to be done about this.Women are being robbed.........It is time to gain back stolen territory! Birth has to be about pure faith. If you want a vbac, you will have to fight for it. You need your husbands support and preferably your family. Nobody else's opinion matters.People will think you are crazy......but they don't have to live with the regret. This is weighing heavy on my heart as I approach my fourth childs 1st birthday on the 16th of November. She was a vbac after three caesareans. It CAN be done!

Micklyn said...

What a great post, so encouraging and informative! I was induced with my first child and it ended up a c-section, and an awful experience. With my next child, I had access to the internet for the first time (I didn't with my first pregnancy) and was able to educate myself so much more... I had a wonderful home unassisted waterbirth - such a healing experience! and another one with my third child. But with my fourth child, my womb ruptured after a day of labour and we both nearly died. Having said that, I believe God was there throughout that terrible experience and has used it for his purposes in my life and to strengthen my faith. My fifth pg ended in a c-section at 36 weeks, my 6th was a c-section at 35 wks and 2 days (I went into labour early and baby was born with pneumonia and a collapsed lung) and now I am 28 weeks pg with my 7th pg and still dreaming of a natural birth. Still praying for a miracle! Though I will go ahead and plan for a c-section at 36 or 37 weeks (my rupture occurred at 38 weeks) I keep thinking that NOTHING is impossible for God. : )

Linnie said...

Wow, What a testimony! Thank you for sharing Micklyn! Praying with your for God's perfect will in this pregnancy.

Linnie said...

Praise the Lord, Tanya!

Huisvrou said...

Ken ek nie daai induksies nie!! Met die dat ons 80km van die naaste hospitaal woon, was dit bykans 'n gegewe. Met eerste - induksie, want sy sou oor Kersfees kom en ek neem aan dr het verkies om eerder die tyd saam met sy familie deur te bring....

Tweede: geboorte sou in groot stad - 175km van ons af - wees. Dr het besluit oor die datum, want dit pas hom en pa.....

Derde: Ek wil soooo graag normaal in kraam gaan. Bid, bid, bid. Maar, dr se dogter hardloop comrades en sy gaan soontoe, ek sou by kollega moes inval en het nie kans gesien nie.

Vierde: Prys die Here!! Hy laat my in die nag wakker word - krampe. wonderbaarlik het ek my eerste vol-normale geboorte beleef. Weliswaar die een met die langste kraamproses, maar ek het dit beleef.

Gelukkig nie met een pynstiller of IV gehad nie.... Normaal gekraam sonder instrumente of keisers.

Nou sou ek graag weer swanger wou wees en by die huis kraam - As die Here Wil.

Linnie said...

Dankie Marelize, vir die deel... bid saam met jou vir daardie hartsbegeerte!!

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