Elise is a birth and postnatal doula and has generously shared the birth story of her third baby Dimitri. This birth was in Swindon, United Kingdom.
Dimitri was born via an emergency c-section, after transferring from a planned homebirth. Elise arrived at the hospital prepared with a birth plan outlining the “natural cesearean ‘woman-centred’ technique”, which includes a delayed ‘incision to delivery’ time and delayed cord clamping.
“I am sharing my story with you today so you know it can be done, a natural caesarean section can be achieved, delayed cord clamping can be performed, even during an emergency situation….but you need to be prepared and assertive.”
My ‘Natural’ Caesarean: a gentle procedure for mother and baby (even during an emergency intervention)
13th March 2012 – Birth of Dimitri Paul Olivier, 9lbs4oz (4kg325), 58.5cms, 3rdbaby
We had been planning long and hard for the upcoming birth of our third baby. We were hoping for a lovely home birth in water. Being a doula myself, I was educated on the subject and was also preparing myself for the challenge. I forgot to say that I had my 2 first babies by caesarean births too so, as you can imagine, we didn’t get much support from our healthcare providers when we requested a home birth….Nevertheless, my husband and myself were determined to attempt it and knew that it was the best and safest option for me and the baby: labouring in the comfort of my own home, where I felt most secure, with the right people next to me.
My 2 previous sections were medically necessary: the first one was an emergency section whereas my second was planned (which saddened me). I knew exactly what I wanted to avoid and I couldn’t express how much I wanted to give birth vaginally. I was ready. I had done all my work, mentally, psychologically, physically etc…. and we had a fantastic doula who knew how we needed to get prepared and what support we would need on the day.
I never wanted to prepare myself for the eventuality of a 3rd caesarean. The idea of it frightened me….and I didn’t want to let fear intrude into my birth. I didn’t want the adrenaline to jinx it. I felt that even considering a 3rd section being an option meant I was defeatist, that it was a lost battle ….so why attempt then?…However through my personal previous experiences and through my knowledge as a doula, I knew that birth is not always what you want it to be. So I reluctantly included 2 more sections on my birth intentions: what to do in case of transfer (to hospital), and a clearly detailed protocol to follow in case of emergency caesarean…I am so glad I did add those 2 parts.
2.36am, Monday – 39 weeks 6 days
I was sleeping and dreamt that my waters had gone. Then I woke up to strangest feeling of hearing the waters pop inside of me. I stayed there, lying down for another 2 hours, and never told my husband, secretly savouring the moment….After a planned caesarean, it was nice to know that I went into labour naturally and it was a special moment between me and my baby.
After a couple of hours, I woke my husband up, shared the news and went to the toilets where the waters started trickling down my legs….That’s it! I was not afraid at all. The rushes were gentle (contractions), but were frequent from there on, probably every 5 mins. They became more and more intense as the day went on. I was feeling good though, I was walking, moving, belly dancing and rolling my hips on my exercising ball whilst listening to my music. All was going well.
My husband called our doula around 7pm to give her an update. We knew that chances were that I was going to be in full on labour (2ndstage) over the night…as he was talking to her, the rushes intensified a LOT and I asked her to come. We also informed the midwives at the same time. Jady, our doula, arrived at 8.30pm and the midwife came at around 9.15pm. At that point, it was clear that the baby was back to back as my back was hurting during the rushes.
At 11.30pm, I reluctantly accepted to have an internal exam and I was 6-7cm. I could finally go in the water! Some of the pain was lifted straightaway however I felt the urge to push with each rush. After 2 or 3 hours of this, whilst trying to change position in the birthing pool, my midwife asked to examine me again. I really really didn’t want to but I knew that we couldn’t take too many risks as we were attempting a vaginal birth after 2 caesareans.
Out of the pool I came, to try and shift positions first. I went on the toilets but really couldn’t stand it. They suggested I’d lie down but as I walked to the lounge, I could not see myself lie down on the floor so I went on the sofa. The next rush came and I lost some blood. I saw my husband’s face and knew something wasn’t right. He asked my doula to come and she herself told the midwife. I had another couple of rushes and I could see that everyone started worrying.
I was losing very large amounts of fresh blood. The midwife asked me if I could feel pain around my previous scar…and I could…..My world was falling apart at that point but I quickly made the decision to transfer, even before the midwife tried to persuade me to. I think she was surprised…but as much as I wanted to give birth at home naturally and that the risks of uterine rupture were low, I knew what the pain around the scar site and the fresh blood could mean.
At that time, I let fear invade my body and my mind.
I had pain.
I felt disappointment….the kind of disappointment that I knew it would be hard to overcome, to heal from.
I felt I had deceived everyone around me.
I felt I had let my baby down by not giving my baby the best and most gentle birth.
I could feel all this, but I had to let my dream go and adapt to the situation whilst trying to manage the pain.
The rushes were hard at that time. I was in the ambulance, alone (by this I mean my husband and my doula couldn’t come with me) and I had to accept what was happening. They offered me gas in air at that time…and I took it. Adrenaline had won and I could feel pain, real pain so my hormones could no longer do their job of helping me through the rushes. The rest of the ambulance ride is a blur. I remember arriving in hospital, in a room, lots of people around. They asked me to sign the consent form. I had seen it twice before so we knew what it meant.
Category 1 caesarean – suspected placenta abruption
The blood loss was an indication of a potential placental abruption, which is where a section of placenta has separated from the uterine wall, causing maternal blood loss and risking fetal hemorrhage. However my baby was being closely monitored and his heart rate was excellent at all times, indicating he was still safe.
I heard the staff declare it’s a category 1 caesarean, meaning there was no time to discuss too much. I heard my lovely husband tell them that they needed to follow our protocol (birth plan) and I could hear the surgeon reply ‘no, it’s a standard procedure so we will execute it as a standard procedure’.
My husband and surgeon exchanged the same words twice….and then my rush finished and I jumped in, shouting we were not going to the theatre unless they accepted to follow the protocol (for a gentle caesarean) and that my doula was also allowed in. (Well, I actually swore at him in my stressful state but I won’t repeat those words)
The surgeon left the room saying that no-one talks to him like this….but he came back 2 minutes later and accepted all our conditions. The 3 of us were so relieved; we were going to have the best birth we could under the circumstances.
‘Woman-centred’ emergency c-section
I was wheeled into theatre, and the bright lights were dimmed down. No chat between the staff, no music of their choice….just total respect that I was there and that I wanted it to be calm in there, as requested in my birth intentions.
My doula was stroking my hair, it felt good to have someone look after me rather than solely on the baby being born. I know that might sound selfish of me but this little detail made it much more pleasurable than my 2 other sections. I felt cared for, not just there because I had to be.
They placed all cannulas and equipment away from my chest and right hand. They turned the volume down for me.
Then the staff were talking to me and telling me what was happening. They “walked the baby out”, meaning they delivered his head and then waited a while, maybe a minute (this allows time for the baby to recruit blood volume for the lungs to expand, and for the baby to clear some of the amniotic fluid and gently begin respiration).
The curtain was dropped so I could see the rest of the body being born with the next rush (contraction)– my baby was being gently squeezed out by my uterus, instead of being pulled out. I believe this is why this baby, although being born by caesarean, wasn’t full of mucus like my other 2 babies were.
Then, the surgeon passed the baby onto the midwife. We were able to discover the sex of our baby by ourselves. The midwife held our baby near us for a few minutes, waiting for the cord to stop pulsating. She was also performing the APGAR on him and I think he scored full points at both 1 and 5 minutes. There was such a sense of calmness in the room, it was amazing. It didn’t feel like this baby was being born through an emergency caesarean section. He was amazingly quiet and bright….and the perfect colour. By not clamping his cord straight away, we gave him his full volume of blood. He was now learning to breathe air on his own, whilst still getting blood from the placenta…at body temperature! He was getting 2 sources of oxygen.
The cord was clamped approximately 5 minutes after he was fully delivered. The photograph above shows the surgeon pinching off the cord as they prepared to clamp.
My son was not transferred to the resuscitaire, but rather straight onto me, on my chest. No need to weigh him for another few hours or even days.
When I felt like he was getting cold and I was uncomfortable, daddy took him against his chest, under his shirt. He then gave him back to me when we were in the recovery room, when I fed him for the first time. We preferred to give him oral Vitamin K later that day rather than an injection in his leg few minutes/seconds old.
We took the placenta home to make placenta remedies. That was another thing we had to pre-organise, not to forget to take a cooler bag to bring the placenta home.
The only thing they could not do for us is use our sterilised hemp string as clamp, so they had to use the usual big plastic one.
Planning for all outcomes
I am so grateful we did force ourselves and did prepare ourselves for all eventualities….and here is one piece of advice I would give, is to allow things to go not the way you want and be prepared. Had we not clearly written our intentions, we could not have given them verbally, under pressure there and then….and the surgeon would not have allowed it to happen.
Be strong and be assertive. Don’t let them steal this from you. Of course, some medical conditions do not allow delayed cord clamping during a caesarean section, but most do. I had a suspected placenta abruption. This was the cause of the extensive bleeding, but it did not prevent all this to take place. (I must add that all readings coming from the baby were good and didn’t show him to be in distress.)When we put our foot down, we took control back of the birth. There is nothing we could have done better. Transferring was the right decision to make….and knowing that we did the right thing and we gave a gentle caesarean birth to our baby makes us proud and it helps me heal over my lost dream of giving birth at home, in water, vaginally.
I am sharing my story with you today so you know it can be done, a natural caesarean section can be achieved, delayed cord clamping can be performed, even during an emergency situation….but you need to be prepared and assertive.
One last thing, the irony of the situation is that the surgeon and all their staff were so amazed to have witnessed and participated in this that they said they would write a paper about it. It was their first delayed cord clamping during a caesarean section in this hospital, and it was an emergency one! They have ~4000 births per year! That’s quite an achievement!
Thank you to Elise Bochereau Doula for sharing her story and personal experience with the ‘woman-centred’ caesarean section technique.
Please see this article Delayed Clamping & C-Section for a discussion of women’s options.
For more information on this surgical technique, designed to improve women’s experience and the baby’s transition in surgical birth, please see this BJOG article A Natural Cesarean: A Woman Centred Technique