My Natural C-Section

My Natural C-Section

It was June 7th 2016, one day past my due date when it happened…my perfect pregnancy came screeching to a halt with a look, a head nod, and the statement, “your baby is breech”. How could this be? I had been doing everything and I mean everything I could to ensure a healthy positioning and prenatal care to support a home birth. I took 12 hours of Birth Bootcamp classes, I was doing pelvic gyrations on my yoga ball daily, I was following the miles circuit, seeing a Webster Certified chiropractor with specialized focus in baby spinning, and of course I was meticulous about my nourishment and supplementation. How could my body have failed me? How could I have been so naive to believe my baby was LOA (Left Occiput Anterior: ideal positioning for vaginal birth) when told and not demanded an advanced ultrasound?

Before I could dwell too long in these doubts and second guesses, it was necessary that I make an emergency appointment with my midwife’s coordinating high risk ObGyn for an assessment. I took one day to mourn the loss of my perfect natural birth. The loss of experiencing the true capabilities of a female body, the ability to birth my daughter, to push, to feel immense pain, to connect on a deeper level with my husband was all something I had not considered a possibility and now a cold reality. I knew going into the appointment that a c-section was likely the recommendation as my advancement in the pregnancy, the weight/size of my baby, and falling fluid levels made a vaginal birth unlikely. I was told by my midwife that after losing a baby through at home breech birth she would not consider it especially as my first birth. In the appointment my ObGyn noted the fluid levels at dangerous levels paired with a packed uterus which would not allow for external cephalic version or manipulation to rotate my baby and attempt vaginal delivery. The rotation of my baby at this size posed high risk for placental abruption which is the number 1 cause of death of laboring moms and something I did not want to mess with…So I had 6 hours to prepare for a C-section this was how my daughter would enter the world. As it turns out I had a Mullerian fusion defect of my uterus which engulfed my baby’s head. This defect prevented any natural approach from aiding in rotation or positioning of my baby.

I committed to releasing the guilt, questioning, and shame that went along with this surgical birth and instead focus on how I could ensure it was the most natural c-section possible while attempting to minimize the impact on my daughter. My primary concern was of the sterility. I had read and lectured on the research of c-section babies and their gut bacteria, the role of delivering a child from a sterile amniotic sac to a sterile surgical suite is far from natural and missing the inoculation of bacteria that vaginally birthed children receive by passing through the canal. I was also concerned about the cord blood and placental removal. I knew that the immediate clamping of the cord and abrupt removal of my placenta vs. a delivery which is done with vaginal birth could limit my baby’s red blood cell formation, oxygenation, and negatively influence blood pressure, blood sugar, and ultimately growth, development, and immunity. Finally I was concerned about the emotional and hormonal effects of abrupt surgical removal of my baby and delayed bonding. I had read studies on mothers having attachment and breastfeeding issues with baby’s born through c-section as they lack the oxytocin surge and natural cascades of hormones that occur with vaginal birthing process.

Below are my approaches that I used to attack these 3 elements. I hope my process is helpful for you and that in sharing my experience you can make peace with your body and its functions beyond your control while ensuring your child comes into this beautiful world in the healthiest way possible!

Vaginal Inoculation and Probiotic Support

As I arrived to the hospital following cleansing with surgical soap (I made sure not to insert any to the vaginal area). I took a non-sterile 4×4 gauze square and inserted it into my vagina. I kept it in there for 2 hours and then prior to going to anesthesiology I removed it and stored it in a ziplock bag that my midwife held onto for post-delivery. It is important that both the gauze and the storage container are non-sterile as to not kill the vaginal cultures. When Stella, my daughter, was born within the first 30 seconds during the APGAR test my midwife was able to wipe the gauze over and inside her eyelids, nostrils, ears, and mouth. She then had Stella sucking on the gauze for a couple minute cycles over the first hour she was born.

This was the best way to mimic vaginal birth and almost immediately introduce bacteria to my baby. Research supports the role of vaginal bacteria including bifidobacterium and other species to be protective for immune support while providing a healthy start to gut flora promoting healthy digestion, skin, neurohormonal, and cognitive health. Sharing my true vaginal cultures with Stella was my way to imprint her with the unique elements of my birth canal. Yes, my husband thought this was weird and was reluctant to do the swabbing but was 100% on board with having my midwife do it. This was good as she was able to assert herself and get at my baby right away. But for those of you that don’t have a midwife, it is your right and any family member present in the operating room can do this.

Following the vaginal inoculation, at 6 hours post-birth, we gave Stella six drops of Ultraflora Baby. This probiotic with its patented strains has been shown in research studies to improve dermatitis, reduce colic, and promote optimal immune function. She continues to get this probiotic and will through her first two years.

Milking the Placenta with Delayed Cord Clamping

The placenta serves as the fuel source to baby throughout the entire pregnancy. When a baby is born upwards of ⅓ of its blood flow is circulating in the umbilical cord and placenta. If the cord is abruptly cut, the baby can miss out on about ½ cup of blood that is rich in iron and minerals, which can influence neurological development and stem cells which drive development of the respiratory, cardiovascular, immune, and central nervous system. Beyond the nutrients delivered via delayed clamping the volume influence can aid in heart and lung function with more fluid to flow through these organs supporting brain as well with more oxygenation. With a c-section, it is not possible for delayed clamping of 5 minutes after birth of until the placenta completes pulsing, but you can request a delay of 40-60 seconds (this is actually significant) and encourage your surgeon or team to milk the cord thus applying pressure from the placenta along the umbilical cord to your baby to encourage the flow of blood towards your child.  

Gentle Cesarean Section with Active Participation

Birth is a process of bonding and connecting with your child allowing your body and her body to perform the miracle of delivery with each pulse drawing you closer to meet your baby. In a c-section birth, many women feel that their baby was removed or taken from their body rather than birthing the baby from their body. This process can lead to postpartum depression, PTSD, and issues with breastfeeding and bonding. A gentle or natural cesarean is an approach to surgical birth including visual access to the baby being born and immediate skin-to-skin contact that is on the rise due to both medical outcomes and positive feedback from the mother. Following the incision, in a non-breech position the surgeon can aid in “walking out” the baby allowing natural progression and breathing. However with my situation Stella had to be pulled out butt first and this was more complicated by my uterine defect which required the surgeon to enlarge the incision and insert his hands up into the corner of my uterus up to his forearms to remove Stella’s head that was engulfed in my uterus. I knew this was going on as I requested a regional spinal block vs. general anesthesia this allowed me to be present mentally and emotionally during the process. I had the IV put in my non-dominant arm so I could be free with my right arm to stroke my baby’s head within the first minute of her birth and help her find my breast to latch with direct skin-to-skin contact. With the intensity of my situation, I did start to get lightheaded and requested my husband take our baby after the first 10 minutes and he was able to continue the skin-to-skin bonding, but some mothers are able to hold their baby throughout the surgical repair.

We also had music playing in the operating room, Stella was born to Van Morrison Astral Weeks with lyrics:

Could you find me? Would you kiss-a my eyes?
To lay me down
In silence easy
To be born again
To be born again

She was lifted out of me to these lyrics and my husband and I were locked eyes crying, hand grasped, and looking up at our beautiful baby. It was magic with her wailing overriding his gentle voice and guitar strings. We knew our life would be changed forever.

Overall, I quickly made peace with what was and accepted it verses dwelling in what was not. I was ultimately grateful to have birthed my baby through a natural c-section now knowing my uterine defect and the reality that she would have never descended and may have not made it out or had an emergency transfer and higher stress situation. We welcomed Stella Virginia Miller into this beautiful world June 8th 2016 at 8 lbs. 12oz and 21 inches in a peaceful setting supporting her in the best ways we could.

Links to support vaginal inoculation and probiotic support:

http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html

http://www.npr.org/sections/health-shots/2016/02/01/464905786/researchers-test-microbe-wipe-to-promote-babies-health-after-c-sections

 

Links to support delayed clamping and milking of cord:

http://archpedi.jamanetwork.com/article.aspx?articleid=2296145

http://www.ncbi.nlm.nih.gov/pubmed/22094494

https://www.nih.gov/news-events/news-releases/umbilical-cord-milking-improves-blood-flow-preterm-infants

 

Links to support gentle cesarean:

http://www.npr.org/sections/health-shots/2015/03/09/390977656/the-gentle-cesarean-more-like-a-birth-than-an-operation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/