I know I just posted about c-sections and sometimes I wonder how much babble about it my readers can handle, but I’ve been meaning to write about these issues for awhile and I wanted to address some of the comments on my last post… so I decided now was a good time for this post. Thanks for putting up with me

I feel I’ve made tremendous progress in dealing with my c-section. I still rant about it on occasion, but much less tears. I don’t know the stages of grieving… when does anger come in? I think that’s where I am. Some days I’m even like “yea I had a c-section, who cares? no big deal” and other days I’m still a mess. I think the “who cares” days are a coping mechanism, because of course I still care–a lot.

Two things in this post. First–there are 2 fairly recent realizations I’ve had about my c-section that I’m having trouble getting past. Second–a response to many of the comments on my last c-section post.

First… The hospital stay, the surgery, the mother-baby unit… it’s all blurry. Random memories pop into my head, even still. And right now, there are two that I absolutely cannot get past. They’ve been lingering in the back of my mind for probably a month now (that’s how behind I am on writing this post). These two things… I’m not sure I can ever get past… I get SO very angry thinking about them. Ok.… first.…. I felt the pressure. I think it’s the closest thing I have to feeling anything of a natural birth. I’ve heard that when it’s time to push, you will know it–no questions asked. So obviously I wasn’t there, but I definitely felt the downward pressure. I remember getting really excited and when the nurse came in the room, I told her about it–in my super excited, smiley voice, like “the baby is coming soon!” But.… the nurse completely discounted my feelings. She told me the pressure couldn’t possibly be the baby. She made me think that maybe I had to go to the bathroom. Or that I couldn’t really feel it because I had an epidural. I remember being SO disappointed, my body physically slumped down. And I totally believed her. I thought “oh shoooooot, this isn’t it, I’m not close yet.” But I KNOW that’s what it was. I was at 8 cm and had just gone to +1 station. It breaks my heart. That was the feeling of him moving down (not being stuck), that was the feeling of  the beginning of delivery. How much longer till it was time to push? How much longer did I need? a;slkjfd;alskjfda;lsdjf;lakdjf

The second thing… damned if I do, damned if I don’t. They told me I needed an internal monitor to check the strength of my contractions (because I wasn’t progressing “fast enough.”) They said if the monitor showed that my contractions weren’t strong enough, even with all that freakin’ pitocin, I’d need a c-section. I freaked out, they put in the monitor and after awhile a nurse came in to look at the charts. I asked her what the contraction strength looked like and she frowned and said it looked like they were NOT strong enough (= c-section) but that the OB would have to look at them. I freaked out some more. The OB came in and she said–well, the contractions are strong enough!–and I distinctly remember smiling and getting really excited. Oh THANK GOD! That means they’re okay and I don’t need a c-section, whoohoo!! .…… and then the OB continued her sentence… “So what that means is that they’re strong enough but they’re not doing anything. they aren’t doing their job. And we don’t know why. He’s probably stuck and too big to fit out. So, you need a c-section.” Heartbreak. I sobbed, immediately. WHY didn’t I realize in that moment what they just did to me?! I didn’t realize it for months afterward.

If the contractions are NOT strong enough, I need a c-section. If the contractions ARE strong enough, it means they aren’t working and I need a c-section. WTF?! CAN SOMEONE PLEASE TELL ME WHAT THE EFF WAS THE POINT OF THE INTERNAL MONITOR IF I WAS DAMNED EITHER WAY. PLEASE. WHY why why did I not see their nasty, sneaky, manipulative ways?!?!?! Why didn’t I notice?! The outcome was c-section in their minds no matter what the fuck the charts said. I HATE PEOPLE. and now I’m crying. Who can help me get past these two things?! BLAH.

Second… I got quite a few comments in my last c-section post telling me not to worry, it’s not my fault, etc. Thank you, really–I know you all mean well and are trying to help me out. But it’s so much easier said than done. I had an unnecessary c-section and I still replay that last moment in my head over and over. The moment we consented to the surgery. (I know it’s not healthy to play the “what if” game, but I can’t help it, yet). What if I said no one more time? What if I asked for 1 more hour? What if… ? So yes, of course I still feel like it was my fault I ended up with the c-section, even though I know you will all tell me it was the system that failed me. I’m not there yet, okay? I hope one day I will get there, absolutely. But I’m not yet.

So yes, there are long-term side effects of having c-sections and if I have any of them, or if Ryan has any of them, I will of course feel that it is my fault because I feel that the c-section was my fault. For now, anyway, that’s how I feel.

As most of you know, I had an unnecessary c-section and I’m still dealing with my feelings about it (mainly anger at this point… and still some huge disappointment in myself). Many people have suggested I write a letter to my OB about it. Whether I actually give it to her or not, just writing it will be healing. Most of you also pointed out the fact that I will probably end up writing and re-writing and re-writing… So… this is what I’ve managed so far for my first draft:

Dear Dr.,

You’re a bitch. And a disgrace to all women.

Truly,
Emily Dickey

((Can I swear on here? lol. If you know me in real life, you know I don’t swear.… ever. So when I do… you know I mean it–just ask my husband ))

Alright, I stopped by the hospital today and picked up a copy of my medical records. I got there at like 5 minutes to 5pm so I was just glad they took my request when the office was closing soon.

I asked for everything. She said, “from the whole hospital stay when you were here for the birth?” I said yes. She came back and handed me an envelope and said it was everything. So I took it and left. (I’m assuming they’ll bill me for them? I find it funny she didn’t tell me that).

Anyway… I have diddly squat. One woman on twitter said hers was 30 pages, another said 200. Mine? SIX PAGES. I think she screwed me over. But I have no idea what else should be in here… ok, this is what I was given:

• Operative Record (3 pages, but the last one is blank)
• Discharge Summary (1 page)
• Clinical History and Physical (2 pages)

And there’s really nothing of interest. Except the discharge summary does not match the clinical history (discharge says I got to 0 station, history says I got to +1) And I am certainly positive the OB told me I was at +1. Reason for surgery? Failure to progress. The OB’s operative records says “arrest of descent” and “arrest of dilatation.”

So am I missing papers?? Nurse’s notes?? Doctor’s notes?? Or is this really all of it??? If this isn’t all of it, when I clearly asked for ALL of it and she repeated it… I’m totally pissed. The hospital is 25 minutes away, I work, I  have a baby… I’m so annoyed and upset I have to go all the way back out there. And so annoyed I don’t get all my answers right now. I was prepared for them (I think). I decided I had to do something to make myself happy so on the way home I stopped at Michaels to get Ryan’s Easter basket and then at Starbucks for my favvvvorite: grande no-whip non-fat iced white mocha. And it really did work… it made me happy

And I could use some help with all this incision lingo in the operative record (oh let me point out how hilarious I find the way these records are written–to very clearly keep them from getting sued):

After informed consent was obtained and all questions answered, the patient was taken to the operating room where she was placed in the dorsal supine position with a rightward tilt. She was then prepped and draped in a normal sterile fashion and a Pfannenstiel skin incision was then made with the scalpel and carried through to underlying layer of fascia. The fascia was incised in the midline and the fascial incision was then extended laterally with the Mayo scissors. The superior aspect fo the fascia was grasped with the Kocher clamps, elevated and rectus muscle dissected off bluntly and sharply. The inferior aspect of the rectus muscles were separated in the midline and the peritoneum was then entered bluntly. The peritoneal incision was then extended superiorly with good visualization of the bladder. The bladder blade was then placed and the bladder flap was then created sharply. The bladder blade was then once again replaced. A low transverse incision was then made into the uterus with the scalpel and this incision was then extended laterally bluntly. The infant’s head was then delivered atraumatically followed shortly by the body. The cord was double-clamped and cut and the infant was passed to the waiting neonatologist. The placenta was then removed manually and the uterus was exteriorized, cleared of all clots and debris. The uterine incision was then repaired with 0 Vicryl in a running lock fashion. A second suture of 0 Vicryl was used for an imbrication stitch for excellent hemostasis. The posterior cul-de-sac was then irrigated, cleared of all clots and debris. The uterus was then returned to the abdominal cavity. The gutters were then irrigated and cleared of all clots and debris. The uterine incision was then once again inspected and found to be hemostatic. The fascia was then reapproximated with 0 Vicryl in a running fashion. Subcutaneous tissue was then irrigated, cleared of all clots and debris and then made hemostatic with electrocautery. It was then loosely reapproximated with 3–0 Vicryl. The skin was then closed in a subcuticular fashion with 4–0 Vicryl. The patient tolerated the procedure well. She received preoperative antibiotics and had bilateral SCDs on during the course of the procedure. She was taken to the recovery room in stable condition.

And from the Clinical History & Physical:

…She was expectantly managed until about 12:30 at which point she consented to having her water broken [hm, they don’t mention the fact that it was because they told me they thought I had an infection]. Clear fluid was obtained at that time. The patient continued to be expectantly managed with minimal change and was started on Pitocin about 3 hours later. The patient subsequently continued on Pitocin augmentation until about 2:50 on the morning of 12/26/2009 [type, it was 12/27] at which point her cervix was noted to be 8 cm dilated, 90% effaced, cephalic in presentation, and +1 station. This was an unchanged cervical exam for the past 4 hours [SO NOT TRUE. Maybe the past 2 hours.] The fetal heart tones were in the 150’s with moderate variability and positive accelerations. There were no decelerations most noted, and she was contracting every 2 minutes on 24 milliunits of Pitocin with MVUs between 160 and 190. Given no cervical change, despite adequate MVUs, a primary c-section was recommended for delivery.

PLAN: The plan at this point is to take the patient to the operating room for a primary cesarean c-section for arrest of descent and arrest of dilatation. The risks and benefits of the surgery were discussed with Ms. Dickey including risks of infection, bleeding, injury to the baby, injury to pelvic organs [I’m sorry, but this is bullshit]. We discussed the alternative as well. [Discussed??? Nice word choice.] Ms. Dickey has consented for the procedure. All of her questions were answered. She will receive clindamycin as antibiotic prophylaxis. She will have bilateral SCDs as well.

I just read this post on the Academic OB/GYN blog: Micro Tort-Reform: A potential solution to the VBAC liability issue. This was written after the NIH panel came out and recommended we decrease the number of cesareans and increase the number of VBACs (or at least make it more of an available option to mothers) and cited a huge problem for repeat cesareans being the issue of litigation.

The author of this post suggests a potential solution: a nationally accepted consent form for VBACs and repeat cesarean delivery. It would point out the risks and benefits of both procedures so the parents can make an informed decision, it would discuss what is needed at the hospital in case of emergency and if that hospital meets those standards, and– most importantly, I think– it would say something about how you’re aware of the risks and that by signing the consent, you release the hospital/OBs from any liability.

At first I thought–awesome idea, if it helps make VBACs more available. But then I thought… what if the OB does do something wrong (beyond “normal risks”) and you signed away your life saying you wouldn’t sue? I am not the type of person that would sue–it was my choice and I know what I’m getting myself into. But to have that option completely taken away?

So here are my questions.…

Is that even legally binding? Can signing something like that really stop you from suing–can it really release the hospital from litigation?

Don’t hospitals already have something like this? Do you already have to sign a consent form for a VBAC? OR for a c-section? (Which actually makes me wonder… I never signed anything before my c-section. Is that normal?)

Would you sign it? Do you think this is a good idea?

How does it work when you have a VBAC at home? Don’t midwives have the same insurance issues as OBs???

VBACs (vaginal birth after cesarean, pronounced vee-back) are more difficult to achieve than you’d think. Where I live, there are 3 hospitals and only 1 allows VBACs (ironically, it happens to be the hospital where I was cut open). Within that hospital, there is only ONE clinic of doctors who will perform VBACs. Keep in mind I live in a fairly large city (population of 160,000 — and a total of 340,000+ if you include the smaller surrounding towns that most likely use our hospitals as well). This one clinic has 4 OBs (I think). That’s pretty sad, if you ask me. Makes my choices extremely limited for my next birth.

I completely understand the reason behind this: litigation. Not only are doctors afraid of this sue-happy nation, but their insurance companies urge them not to cover VBACs and some even threaten to drop them if they do perform them. What are they to do?

This past week, a panel of specialists convened by the National Institutes of Health met to discuss this very issue. They decided that VBACs should be an option, they urge that VBAC guidelines be revisited and malpractice concerns addressed, and stated that more research is needed.

Rigorous research shows that a trial of labor is successful in nearly 75 percent of cases.

One guideline they suggest needs revisiting is the one that says if there’s going to be a VBAC, the hospital needs to have an “immediate availability” of surgical and anesthesia personnel. This is not a feasible option in 30% of hospitals (according to 2 surveys) and was the reason they stopped offering VBACs.

VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded.

They want more research done so that each woman can be evaluated independently. What factors make VBACs more dangerous? less dangerous? This will hopefully allow more women the option to choose their birth.

The current overall cesarean delivery rate is 31 percent and the VBAC rate is less than 10 percent compared to 28 percent in 1996.

They are urging that doctors offer mother’s an unbiased look at pros and cons and let the mother decide for herself. The mantra used to be “once a cesarean, always a cesarean,” but research in 1980 concluded that VBACs were safe, as the risk of uterine rupture was less than 1%. After this, VBACs were on the rise. However, in 1996 things shifted back the other way. That guideline mentioned above (for the immediate surgery personnel on hand) was passed in 1999. Of 19 states that record VBACs, 92% of women had a repeat c-section in 2006. And the latest reason, of course, is fear of lawsuit.

Obviously I agree that it should be decided on a case-by-case basis. Some women are at a higher risk than others. But shouldn’t all of us at least get the choice? I’m not high-risk, but I will have to leap through flaming hoops on a flying monkey to get the VBAC I want in this city.

So it would seem I’m not crazy and c-sections ARE occurring too frequently. I am absolutely overjoyed that this conference just happened… 2 months after my birth experience. I am so glad they are working to do something about it.

You can find more information including their statements and reports on the NIH Conference website.

All quotes and stats used above are found in these 2 articles:
National Institutes of Health News
Associated Press

All night I was having dreams about c-sections and people yelling at me. Every time I woke up I tried to replay the dream in my head so that I’d remember it in the morning, but no luck. All I remember are feelings of fear and guilt.

I was terrified of waking up this morning to see any more rude comments on my last post. The first time it happens, I can handle it. When a few more start flowing in, I lose it. My skin is thickening, but I can’t handle it yet. When I open my email and I see something from “Baby Dickey”… a new blog comment… I seriously get knots in my stomach because I’m afraid to look and see if it’s going to ruin my day.

You might ask why I don’t just close comments, but… that’d be a shame because the majority of comments are extremely supportive and helpful to me. I can’t let a few people ruin that. Plus… there’s this thing I strongly believe in called the Constitution and the freedom of speech. I just wish people weren’t so hurtful sometimes–I get they’re defensive, I get they’re trying to make their point, but why attack me in doing so? Over this?

I want to report correct stats and I don’t mind being corrected at all. I’ve also learned my lesson–next time I report something like in my last post, I’ll cite my sources. So let’s have an educated discussion and get all the facts out there… let’s not attack eachother. One of the comments yesterday came from a woman who was also upset with her birth experience, yet she was still “attacking” me. How are we not working together on this? What are we missing? We shouldn’t be fighting eachother. I apologize that my stats upset people, but I did not just make them up, I did read them somewhere. And as soon as I find it again I’ll post it… and if they aren’t correct, that’s fine, we’ll get to the bottom of it.

I don’t want any more c-section nightmares. Honestly, I’m surprised this is the first time I’ve had any.…and sadly, they were caused by my anxiety over getting comments on my blog. I write publicly, so I guess I “deserve it.” Ah well. I just don’t want these few negative comments to scare me away from posting about this again in the future…

I rant about my c-sections here because it’s healing to write it out. I don’t expect sympathy. I don’t expect any comments at all. I’m thankful you guys are even reading those posts. So on that note… thank you SO much for all the wonderful comments and all the support. I know I’d be much worse off if it weren’t for all of you. It’s great to know there are others out there who feel the same–or at least understand–and I’m not alone.

I was planning on writing another post on my c-section about a week ago because it was bothering me again. Then, randomly, I got quite a few comments from doctors and nurses on my “C-Section Thoughts and Advice” post that was written as part of my birth story. They all came on the same day and I’m not sure how… but it made for one hell of a day for me. I cried all day long, and probably most of the next day too. It brought everything back… and the comments were about how the c-section was MY fault… I couldn’t handle it. Where did these people come from?!

I realize I write my life on here to be exposed to everyone. I expected negative comments on my posts about vaccines, circumcision, epidurals, etc. But I never imagined in a million years that I could be attacked because I was complaining about my unnecessary c-section. Call me naive.

But I can see how people in the medical field would get defensive… especially if they’re one of the few good doctors who would never do such a thing as my OB did to me. They must get tired of being bashed stereotypically all the time. For them, I apologize.

BUT… 1 in 3 women end up with a cesarean. What percentage of c-sections are actually NEEDED? 3%. Three percent. Yet some 33% are given and that number is climbing. It’s SICK. And I just found out that 1 in 3 women experience fertility issues after having a cesarean. When I asked my doctor about the risks of this surgery, WHY didn’t she mention that? 1 in 3 in HUGE. That could either be infertility, miscarriages, or just difficulty becoming pregnant. Either way, I will forever blame myself if I’m part of this 1 in 3.

On to the title of my post… someone I know (in real life) had a c-section about a month after me. But it was elective… she asked for it. She recently wrote to me about how Ryan being here is all that matters and that me being upset about my c-section was upsetting her because cesareans don’t make you any less of a woman. I totally get that… and I don’t want anyone else to feel bad about their surgeries just because I do. Every experience is different. She chose hers, I did not. I feel like I failed, she should not. So I guess this is just a huge, general apology to anyone I may have offended. It is hard to talk with people about this who don’t understand how I’m feeling. I don’t know how to describe it to them to make them feel what I feel. Anyway… I wanted to paste what I replied to this girl… and I have a feeling this blog will become, in the future, a place where I post articles and facts about cesareans and VBACs. There needs to be more awareness. And let me just say, phew it feels good to get this out. I need to write it down every once in awhile. Thanks for bearing with me… because each of my “c-section rant” posts will probably sound the exact same, haha.

Here is my response to her: