Baby Arabia meets Daria, a thirty five year old mother of two children. Daria’s daughter aged five was born by emergency caesarean section and her baby son by elective caesarean three years later. In the first of two articles in which Daria describes her different experiences with the two procedures, we interview her about her daughter’s dramatic delivery and her feelings about caesarean birth.
BA: Daria, your daughter was delivered by emergency caesarean section – did you have any idea that this might happen during your pregnancy?
D: I knew that in any pregnancy, birth by emergency c-section was a possibility, but no, there was nothing during my pregnancy to indicate that I would not be able to give birth to my daughter naturally.
BA: Had you made a birth plan?
D: Yes, I had decided that I wanted to have my baby in hospital but that I wanted to have a natural birth with little or no pain relief.
BA: When did you realize that there may be complications?
D: It was a complete surprise. I went to my weekly check up, two weeks before my due date, and my doctor found that my blood pressure had elevated to a dangerously high level. This was not expected as throughout my pregnancy my blood pressure had been stable and healthy. My doctor told me I must go straight to hospital without even going home to collect my bag.
BA: This must have been a shock – how did you feel?
D: I was shocked, yes, because I felt perfectly alright and had no idea that I or the baby were in any danger. Thank God I went to my ante-natal appointment or I would not have realized. I was very apprehensive and full of adrenaline, but I felt that if anything was wrong then the hospital was the best place for me to be.
BA: Were you admitted to hospital?
D: Yes, I was given further tests and medication to lower my blood pressure. The drugs worked to lower my blood pressure but they could not keep it lowered. It was decided that labor should be induced so that the baby be born as soon as possible, and to prevent the risk of pre-eclampsia.
Because this was two weeks before my due date and a cervical sweep had not induced labor, I was given drugs to induce labor. By the following morning I was having strong contractions. I was given information by the medical staff about my pain relief options including pethidine and epidural as I was advised that artificially induced labor, especially when induction is early, can be painful.
I continued in labor throughout the day and was able to have a bath to ease the pain and later I accepted pethidine. I had not wanted to accept pain relief in labor but I came to realize that my ideal birth plan had already gone awry and that I should accept the situation moment to moment and take the advice of my care team.
24 hours after induction I was having strong contractions but not progressing well and my cervix was not dilating. At this point my care team decided to break my waters in order to speed things up. This was not a painful experience but the contractions it prompted afterwards were very intense and I was given an epidural as it looked like labor was going to take time – I was still a long way off the 10 centimeters dilation necessary for delivery.
At this point I was comfortable and moved to the delivery room whilst my drugs were increased to try and push my body into more advanced labor.
BA: Did you know at this point you may have to have a c-section?
D: No, this had not been mentioned. They were more concerned in controlling my blood pressure and using enough drugs to induce productive labor.
BA: So what went wrong?
D: I was strapped to a heart monitor to monitor the baby’s reaction to the labor. Every time the drugs were increased enough to progress labor the baby’s heart rate decreased. This was a signal that the baby was in distress.
BA: Were you afraid that the baby was in danger?
D: Yes, at one point I was alone in the room with my birth partner and we heard the baby’s heart beat decrease to a stop. We pressed the emergency button and a team of medics responded immediately and I was given oxygen and moved onto my side. The baby’s heart rate came back gradually and was strong again. It was very frightening but I have learned since that this is not unusual and whilst the baby is in the womb this is not as dangerous as it sounds as long as medical help is at hand.
BA: So the baby was safe in spite of it being frightening experience …
D: Yes she was safe on that occasion however it was clear that she was not coping with the strength of contractions that the medication was inducing and that every time the medication was increased she was struggling. I was still only 4cm dilated after 36 hours and my body was becoming exhaused so it was evident that I was not progressing. We were in a situation of being stuck as to how to move forward safely.
The doctors tried to take some blood from the baby’s head using a device which would then assess her oxygen levels to determine fetal distress. It was unsuccessful. However, all evidence showed that any further medically induced labor would be dangerous to my baby and any further delay to delivery would be dangerous to us both because of my high blood pressure and the threat of pre-eclampsia. It was at that point we asked to accept that a c-section was necessary and urgent
BA: How did you feel about this?
D: I was exhausted after a very long and unproductive labor and very frightened at this point. I was happy to accept the c-section as I was so worried for my baby’s safety and I could see as well as the professionals that my labor was not succeeding. Hearing my baby’s heart rate decreasing on the heart monitor was one of the most terrifying experiences of my life. I did not wish to continue to repeat the risk of this; I had had enough.
It was a huge relief more than anything, and I was amazed at how rapidly things happened once the decision had been made. There was a sense of urgency which gave me confidence that my care team believed it was time to proceed with the c-section and waste not more time. I was quickly prepared for theater, my jewelry was removed and the nail polish on my toes also; consent forms were signed, and because I already had an epidural in place the drugs were simply increased immediately so that I could have a conscious but pain free c-section.
Delivery in theater was quick and efficient. I felt a lot of tugging and it was quite a rough feeling but my daughter was quickly born and cried immediately – the feeling of relief was immense. She was checked over and pronounced perfectly healthy and I was able to hold her whilst the surgeons finished operating. They still needed to deliver the placenta and stitch me up.
BA: How did you feel that your daughter had been born by c-section?
I was elated and relieved and thrilled that my daughter was safe. I felt we had both survived quite a traumatic experience during which I had been frightened that the outcome could have been very different. I was incredibly grateful to the medical team who looked after us both. It was not my ideal birth, but I realize that sometimes a c-section is unavoidable.
If I had not been induced into labor both my baby and I could have been in terminal danger from pre-eclampsia signaled by my high blood pressure. Once in unproductive induced labor the only safe result in the end was the section and this potentially saved both our lives.