By Megan Kasper, MD
As an obstetrician-gynecologist, I often joke with my colleagues about the “OB birth juju”, meaning that we, as OB/Gyns, tend to have weird stuff happen to us with our own births. The joke often seems like a truth.
My own professional journey started by training as a midwife. It was through my experiences in that world that I realized I wanted to do more, and I eventually went to medical school and did an obstetrics and gynecology residency. I had studied complications in training, but a normal, healthy birth was always a treasure I hoped I’d get to experience someday.
My first pregnancy was unremarkable. I had all the normal aches, pains, and complaints, but no complications. My baby moved constantly, grew appropriately, and I was able to work full-time all the way to my due date. I believed very strongly in following care for myself exactly how I recommend for my patients, and I was dutifully waiting for a 41-week induction date. I had selected my hospital based on the practice patterns of the staff there and the hospital’s baby-friendly policies.
The day before my scheduled induction, I went into labor. Wonderful! I arrived at the hospital and my cervix was 3 centimeters dilated- I was in early labor. Shortly after arriving, while still in the triage room, my daughter’s heart rate went down for a couple minutes. The nurse rolled me to my side, and it came back up. However, there were subtle concerning changes over the next several minutes, and her heart rate never looked particularly healthy. Then her heart rate went down again. This time I had three doctors in my room within moments. Her heart rate came back up, but the senior physician gave me the speech about needing a c-section if her heart rate went down that badly again.
I was devastated. Sobbing, I got moved quickly into the labor room closest to the operating room (OR). I could not believe that the chance of my dreamed-of birth was evaporating so quickly.
Cesarean sections are literally a lifesaving surgery. However, c-section rates have increased consistently and significantly in the last 20 years, without a decrease in infant and maternal mortality rates, suggesting that they are over-used. One of the current strategies promoted by the American Congress of Obstetricians and Gynecologist (ACOG) is to prevent the primary, or first, c-sections. Once a woman has a cesarean, she is much more likely to have subsequent babies by cesarean. However, once a woman has birthed vaginally, she is at much lower risk for delivering by cesarean.
My baby’s heart rate went down a third time for several minutes, and finally came back up. The medical team gave me a moment to take a breath, and say yes to the c-section. I never stopped sobbing. The anesthesiologist placed the spinal, and I asked my doctor to check my cervix one last time. I was only 4-5 centimeters.
Still in shock, I heard “it’s a girl!” announced, but it was a couple minutes before I realized I hadn’t heard her cry. It was another few minutes before they could tell me why: she was stable, but still required oxygen, so she would have to go to the neonatal intensive care unit (NICU). I was still somewhat in shock and questioning my surgery, when the surgeons identified the likely cause of the drama: an unusual placental abnormality called a velamentous cord insertion. I was able to look at the placenta when the surgery was done, and it was the worst one I had ever seen in practice. Right there, at that moment, I knew what could have happened and I never questioned my cesarean again.
There are two aspects of recovering from any birth, whether vaginal or cesarean: physical and emotional. One of my recommendations for c-section moms is to “debrief” with her medical providers after a cesarean. It’s so much easier to process later, if the mother has an immediate resolution of what happened, why it happened, how she felt, and even how the medical team could have handled it better. I often hear from moms who have regrets after their c-section, and frequently those regrets stem from unanswered questions.
I was in good shape during pregnancy, so my physical recovery was painful, but smooth. Emotionally, I had the benefit of understanding why my cesarean was necessary. My medical team was clear, but gave me space to make the decision myself. I didn’t feel bullied. All those elements helped my emotional recovery be almost instant.
My daughter quickly transitioned to breathing on her own and only spent a few hours in the NICU. Two days later I took her home. My own recovery continued smoothly. I was confident that my cesarean was necessary for my daughter’s survival, and I was deeply grateful that we had that chance. I was healthy, had an uncomplicated cesarean, and I knew that I would be a great candidate for a VBAC (vaginal birth after cesarean). I mourned the loss of the vaginal birth experience, but it also made me value that experience more for my patients. I did not experience the emotions many women describe of feeling their body failed, or that they missed out.
It wasn’t long before I was hoping for another child. And of course, I planned to have a “trial of labor after cesarean” (TOLAC), with the goal of delivering vaginally (vaginal birth after cesarean, or VBAC). The story of that birth will be posted next week in Part Two.
Megan Kasper received her bachelor’s degree from the University of Oregon in her hometown of Eugene. Sadly, she never attended a football game while a student there. She graduated medical school from Oregon Health and Science University. She completed her obstetrics and gynecology residency at the University of New Mexico. Currently she practices at Saltzer Medical Group in Idaho. Dr. Kasper and her husband Eric live in Nampa, Idaho with their two children.