<![CDATA[Cesarean Birth After Cesarean - Processing the CBAC]]>Tue, 01 Dec 2015 04:28:30 -0800Weebly<![CDATA[July 04th, 2014]]>Fri, 04 Jul 2014 23:55:04 GMThttp://cbac-support.weebly.com/processing-the-cbac/july-04th-2014Reposted from posts on the ICAN Blog here and here.

Melek Speros


When my CBAC birth story was first published on the ICAN blog a couple months after my baby’s birth, one comment on it really stuck out to me.  It was from another CBAC mom who told me that my feelings about my CBAC would “…ebb and flow, and will vary a lot over time, even when you have had a relatively positive experience.”  ”WHAT?!?” I thought to myself upon reading that.  I was (and am) still riding the high of an empowered pregnancy and birthing experience–a totally different kind of experience than the birth of my first son.  I had unintentionally gone in to my birth expecting to be devastated if I wound up with another cesarean birth–I even cried during labor to my midwives that I would never have a baby again if I had another cesarean.  So I was more than pleasantly surprised to have only positive feelings about my son’s birth. When I woke up from the surgery, the first thing that popped in to my head was “Whoa!! That was awesome, I can’t wait to do that again!” (Of course, hoping that next time it would end in a vaginal birth)

Around month 8 postpartum, what should have been a minor and easily resolved misunderstanding between friends revealed to me that I had left out a really big part of my healing process.  While I celebrated the joy and beauty in the birth of my son, I neglected to give myself space to mourn the loss of the vaginal birth I had worked so hard for.  Through copious and highly emotional email exchanges with a fellow CBAC mom friend who helped me to work through it, I finally gave myself the space to grieve.  And I cried and cried and cried.  I’m crying now even typing about it.  I wanted that vaginal birth so badly and, you know what?  It kind of sucks that I didn’t get it.

In my birth story, I wrote about giving myself permission to feel whatever came along with his birth.  I realized after my minor emotional breakdown that I hadn’t given space to the feelings of grief that came up, not right away, but later on down the road.  I think a big part of me felt like giving breath to those feelings might somehow take away from the amazing experience that was my CBAC.  But I learned the two aren’t mutually exclusive.  Being sad that the vaginal birth I wanted so desperately didn’t happen doesn’t mean that my birth was any less powerful or sacred.

And I think that’s the biggest lesson I’ve learned thus far on my journey.  Give yourself space, freedom and permission to feel whatever you need to feel about your CBAC whenever you need to feel it.  Your feelings on day 1 may not be the same as they are on day 5 or day 17 or day 397, but whatever your feelings are, they are yours and they are valid.

Amy Shireman

Coming to Terms with My CBAC

By Amy Shireman of Shirebacon.com

My older son, Jack was born just over three years ago via a “planned” c-section.  I use the quotes because it was planned for all of two days.  He turned breech at my 39 week OB appointment.  I had a c-section two days later.  From the second I found out that I would give birth to Jack via c-section, I knew that I wanted a VBAC.  When I was admitted for Jack’s birth, my nurse could tell that this was not what I wanted.  As she calmly reassured me, she mentioned a VBAC and that practice I was with had an excellent VBAC track record.  I was beyond thrilled.

Fast-forward two years and I am faced with a decision.  After WEEKS of very strong contractions, I am not dilating past “maybe 1 cm”.  A decision is needed.  Either a RCS or an induction.  I chose induction with a foley cath followed by Pitocin.  I knew that my decision to be induced increased my chance of another c-section but I was positive that it wouldn’t come to that.  I was wrong.  After 20 hours of labor, 8 hours stuck at 7 cm and an amnio-infusion, my little boy was having heart decels, my progress had stopped and no one (including myself) was comfortable continuing labor.  And thus began my unexpected CBAC.

I had done a few things while I was pregnant to cope with a possible CBAC.  First was to accept that it was a possibility.  The other thing I was to have a birth plan of sorts.  Not a true plan, but a wants/doesn’t want kinda list.  No it didn’t sting any less when my doctor sat on the side of my bed, took my hand and told me she recommended a c-section, but I didn’t feel blind-sided like I did last time.  And it allowed me to have some control over what was happening.

When I came home from the hospital after my CBAC, I felt good.  I had labored for 20 hours!  No, I didn’t push, or give birth vaginally, but I had done more than the 1st time around when I hadn’t felt a single contraction.  The medical staff had done everything that they could to avoid another c-section and I was happy about that.  I was disappointed, but I felt OK about my decisions.  And I was OK about not giving birth vaginally.  Or so I thought.

Over the next several months, a few things happened.  My husband and I decided that we were, in all likelihood done having children, people I knew had successful VBACs, I had to leave my OB for insurance reasons, and my sister announced her pregnancy.  And that’s when it happened.  I had a complete breakdown.  I was mad, I was angry and I was sad.  I realized that I would likely never have the vaginal birth that I so desperately wanted.

I had a long talk with my husband.  He tries very hard to understand and he pointed out one very important thing to me.  After Jack was born, I talked about my c-section all the time.  I talked about my disappointment and my desire for a VBAC.  I talked about the c-section itself, I talked about my recovery.  After Xander was born, I didn’t talk about at all.  Maybe it was being busy with a 2 year old and a newborn, maybe it was my easy recovery, but more likely it was denial.  I never allowed myself to process the CBAC like I had done with my first c-section.  On top of my disappointment, I needed to deal with the fact that I would likely not have any more children and never give birth vaginally.

So I started talking about my CBAC.  I started blogging about VBACs, my boys’ birth stories, my feelings.  I connected with some other moms who have had CBACs, I’ve listened to women who had similar feelings about their c-sections and I’ve shared my feelings.  I was starting to feel much better and then BAM! I was blindsided. Twice.

I saw a request on a blog for “unnecessary c-section stories.”  A blogger who was training to be a doula wanted to highlight unnecessary c-section stories and what could be learned from them.  Neither of my c-sections were unnecessary, but I emailed the blogger anyway.  I offered to tell my stories and she proceeded to essentially tell me that I was wrong for being induced, wrong for trusting my doctor and wrong for agreeing to either c-section.   This after I literally explained my experiences in 3 sentences.  I was FUMING.  I wrote a blog post, I engaged in an email exchange with her, I yelled at my husband about her.   She accused me of being defensive because in my heart I knew that I was wrong in my choices. I finally just had to stop. I wasn’t going to convince her otherwise and I didn’t need to convince her.  My feelings and opinions are the only ones that matter and I without a doubt know that I did the right thing for me and my boys.

Then in early August my niece was born.  After my sister told me she was in labor, I waited by the phone and was beyond thrilled when my sister called to say that she gave birth to a beautiful healthy little girl.  You guys, I’ve never admitted this to anyone before.  After I got off the phone with my sister, I cried.  Not tears of happiness.  Tears of jealousy.  I tried SO HARD to have a vaginal birth.  I did everything I could and it still didn’t happen.  I researched everything I could, prepared every way possible and nothing.  My sister? I love her to death, but she’s not a researcher like me.  She basically just showed up at the hospital and 8 hours later had a baby.  I felt like a horrible person for being so jealous.

Later that night I was on Twitter and saw someone tweet something that really put things into perspective.  It was someone who struggled with infertility.  Someone close to her got pregnant super quickly and she basically said that she was insanely happy and insanely jealous all at the same time and that she was glad that she was in a place where she knew that it was ok to be jealous.  That’s when it hit me.  I had to see the words to realize that it was ok.  I’m allowed to be jealous and happy at the same time.  I can feel both at the same time.  And that jealousy is part of my healing and acceptance process.

These two events have helped me immensely in coming to terms with my CBAC.  And I know it’s a process, one that continues even 13 months after my CBAC.  I still have my moments and I suspect that I will always carry with me some amount of disappointment over both my c-sections.  But the important thing is that I know that it’s ok to be disappointed.  I know that my feelings are my feelings and  that it’s not “wrong” to have them and that just because it’s been more than a year since my CBAC, I don’t have to be over my disappointment.  I have connected with a lot of people who I can turn to when I need someone to listen to me or encourage me.  I am forever grateful for that.

Melissa Tyler-Belmonte

Many women, myself included, have planned VBACs (vaginal birth after Cesarean) or HBACs (homebirth after Cesarean).  I, myself, had a planned HBAC turn into a CBAC in 2007. After my birth, as I began processing my experience and my feelings, I turned to the internet birth community for help – and found not much out there. There were many triumphant, happy VBAC/HBAC stories (and of course, I cheered internally for every mama out there who was blessed with the birth they wanted) but only a smattering of women talking about their experiences with unplanned CBACs or “failed” homebirths/VBACs. At the time, I was also not able to find a local ICAN chapter to share my experience with. Feeling unrepresented in the birth community was a sad thing for me, but I continued on my journey processing my birth and trying to find and talk to other mothers who had been through the same thing as myself. I am thrilled to be contributing to the ICAN Blog on this topic, and I hope that “CBAC Week” will be an invaluable resource to all the C-section/CBAC mamas to come!

To sum up my own experiences, I had my first C-section in 2004 for breech presentation, amongst other issues. I planned a VBAC for my next baby as soon as I knew it was a possibility. In 2006, I found out I was carrying twins. Still determined to VBAC but being turned down by OB/GYN providers as a VBAC candidate due to the twin pregnancy, I found a homebirth midwife who would accept me as a patient. Unfortunately, due to breech/transverse positioning and stalled labor causing failure to descend once I hit 10 centimeters, I underwent a subsequent C-section to deliver my babies after over 24 hours of labor. My extended birth stories can be found here.  My “failure” to HBAC hit me like a train – it was so unexpected, something I had hardly considered as a possiblity. I had been so pumped up by most birth literature that I was doing what my body was designed to do, I had done everything “right” for optimal fetal positioning, I had worked hard to stay pregnant as long as possible, including enduring a ridiculously high-protein diet and spending most of my time resting despite having a toddler. I refused to let negativity into my space – I didn’t even pack a hospital bag. I was in no way prepared to walk into a hospital and acquiesce to another Cesarean, but it happened.

My first step of processing happened before the C-section even occurred. I made it a point to say to hospital staff “I am here for a Cesarean.” I knew that my chances of being “allowed” to VBAC at the hospital were almost nonexistent, and I knew that if I asked for a C-section when I walked in rather than having it pressed on me by hospital staff, I’d feel better about it later. It was my way of taking control of the situation, and keeping it my birth, rather than the birth the hospital gave me. Obviously, that is not an option for women who have already gone through their unplanned CBAC – but this tip may be helpful for anyone making a contingency plan for a CBAC, should their VBAC/HBAC not happen as they planned. Indeed, asserting myself and calling the shots was also a major factor in planning a peaceful, empowered CBAC with my fourth child. I think that most birth trauma stems from a loss of control of your birthing experience – so planning ahead of time ways you can remain “in the driver’s seat” even if your birth plan goes awry is a great idea.

My second tip is to ask for help. So many of us who have planned VBACs or HBACs planned to be mobile shortly after birth, able to care for ourselves and our children with relative ease, and may not have planned ahead for the alternative of surgical recovery. Be vocal about your needs with family and friends. Don’t push your body too hard – allow yourself time to recover and allow those around you to pick up your slack while you recover and enjoy your baby. Don’t feel compelled to “make up” for your birth outcome by being Super Mom – this was my mindset early on, and I definitely extended my recovery days and possibly even weeks by doing too much. Be gentle to yourself, respect your body’s need to recover. This tip is especially important if you labored before your CBAC, and especially if you labored for a good long while – your body went through labor AND major surgery! And most importantly, asking for help allows you time to rest and focus on emotionally processing your experience.

Emotionally, coming home to find the birth paraphernalia - the birth pool (drained, but still inflated,) some gloves, part of the birth kit – still out and around was perhaps the most difficult part of the experience for me. I allowed myself to have a bit of an emotional breakdown while my husband removed the pool and the other items. Allow yourself to process through emotion – whether it’s crying over the loss of your desired birth, or laughing over memories of the process. Bottling it up to deal with later is tempting when you’re exhausted and have a new baby to care for and family coming in and out visiting, but this step is vital. And all kinds of emotions are to be expected. I experienced grief over the loss of my experience, shame that I wasn’t strong enough to push my babies out, pride and wonder at how well I had handled labor, anger at the family members who told me “I told you so,” and, due to the circumstances of my CBAC, relief that everything had turned out okay and that the complications I experienced hadn’t been worse. Allowing myself to feel my feelings and accept them as they were, without overanalyzing or being angry at myself for feeling them, was a tip given to me by a therapist many years before I started having children, but it helped me process this particular experience beyond measure. No matter what you are feeling about your unplanned CBAC, it is valid.

Talking about my CBAC experience helped so much, and still does. Over four years later, I still feel comforted telling people about my births; it’s almost as if I’m unloading a small piece of the burden onto the listener. My husband heard most of it, and I was blessed that he, too, felt the sadness and grief over the loss of our birth experience that I did – that commiseration was invaluable. I also found tons of commiseration online, in forums and on the blogs of people who had been through similar experiences. ICAN – both meetings and online groups – can be invaluable in connecting you with other mothers to share your experience. For those uncomfortable with the internet as a medium for processing their feelings about their birth, therapy with a psychiatrist or counselor is also a valuable tool. Talking about your emotions makes them tangible and can help you feel validated, and feedback from the listener is also a valuable tool in dealing with the emotions surrounding your birth experience.

My final tip is that if you felt mistreated or marginalized during your CBAC, speak up about it. Make a call, or write a letter to your care providers letting them know that your birth experience was unsatisfactory and what they did to contribute to that. I was able to verbally tell the doctor who performed by unplanned CBAC that her comments about the integrity of my uterus made me feel terrible and as if I was a womb, rather than a person, to her, and this led to a conversation that I believe helped her to realize that patients with unexpected birth outcomes required support and gentleness rather than flippant comments on the way out of the OR. You don’t have to send the letter if you don’t want to, but getting the feelings down on paper in a manner you can make more sense of them can be helpful in your healing process as a way to “unload” those feelings. If you choose to send the letter, you can do so with the knowledge that your experience may pave the way for better care for other mothers. And conversely, thanking a provider who was supportive and sympathetic through your unplanned CBAC can also be cathartic and open up another line of communication that allows you to share and process your experience.

I know that as time goes on, in my own experience, processing became easier and easier. It’s hard to look at my two four-year-olds, one feisty and one sweet, and not feel content with what was a rocky beginning. In my opinion, the most important thing to take away from any birth experience is that your feelings are completely valid no matter what they are. Even the best birth can leave some negative emotions, and even the scariest, most traumatic birth can have bright spots or fortunate outcomes. There is no “perfect birth,” and being able to share your experiences with others is the best way to move towards peace and healing. I am grateful to be given a spot to share my experiences here on the ICAN Blog, I am thrilled that ICAN is addressing the topic of CBACs this week, and I hope that my tips for processing your CBAC experience are helpful in your journey!

Catherine Harper


Like most cesarean moms, the story of my VBAC-turned-CBAC begins with the birth of my first child.  During my first pregnancy, my husband and I prepared for a natural birth by doing all the right things: taking Bradley classes, hiring a doula, reading lots of books, talking with other natural birth moms, exercising, eating healthy, and on and on and on.  But after a 46-hour labor that included unplanned interventions and a malpositioned baby, my son was born via cesarean section.  Needless to say, though I was completely in love with my sweet baby boy, I was devastated by my birth experience and mourned its loss for months.

Thankfully, I was able to breastfeed my son, and that became my saving grace.  Yet while I nursed him, my thoughts often turned to the birth I did not have, and I daydreamed about doing it over again.  I prayed endlessly that my little boy would just be enough for me, reminding myself that, whether I gave birth vaginally or by cesarean, the end result, that sweet baby, would be the same.  But that wasn’t enough, and I just couldn’t fill the endless ache in my heart.  I replayed my birth over and over again in my head, looking for things I should have done differently.  I hated Sundays in those first weeks and months, because that was when I went into labor, and I would literally hold my breath until 7:28 on Tuesday mornings, because that was when my son was born.  I turned my head away driving by the hospital and felt tears prick my eyes when I saw the huge signs of a pregnant woman advertising the new Women’s Center there.  I couldn’t stand to look at my maternity clothes or even put them away, because they reminded me of a happier time, before my c-section changed me.  I was truly mourning the loss of my vaginal birth, and I just had to work through the stages of grief.  My sadness didn’t affect my feelings for my son,and I cared for him easily and found joy in doing so, but inside, my heart was broken.

After finding ICAN, I was comforted by the knowledge and strength of its members, and gave my grief purpose by preparing for a future VBAC.  I’m sure, to those who know and love me, I seemed obsessed, but educating myself gave me something to focus upon in those early months of sadness.  I befriended other cesarean mothers and joined a local mom’s club, swapping birth stories whenever the topic came up.  I was surprised to discover that so many other new moms had experienced similar circumstances, and there seemed to be too many traumatic birth stories in our group.  I left my obstetrician’s practice when she didn’t appear supportive of a VBAC, and began looking for a new doctor.  I attended any VBAC webinar ICAN offered, cheered other moms as they planned their VBACs, and dreamed of the day when I would have mine.

As the months went by, my grief lessened, as people said it would, though I continued to focus on my VBAC plans extensively.  Nine months after my first son was born, I became pregnant with my second child, and though the timing was earlier than originally planned, my husband and I were thrilled.  I should mention that I have scleroderma, a connective tissue disease, and Grave’s disease, an autoimmune disorder that causes hyperthyroidism.  Though both issues are well controlled and don’t impact my daily life, they automatically make me high risk during pregnancy, and because of this, I am not a good candidate for a home birth.

Still hoping for a VBAC, I found a local OB-midwife practice with a great VBAC rate, and though I fought hard to avoid the high-risk label, I did have to see a perinatologist throughout my pregnancy, just as I did during my first.  At my 16-week ultrasound, our baby was found to have several choroid plexus cysts, which by themselves are benign, but coupled with a heart issue, can be indicative of Trisomy 18.  My husband and I spent one anxious month waiting to find out if our second child would be healthy, and during that time, I found a bit of a new perspective, realizing I would gladly give up a chance at a VBAC in an instant to protect my unborn child.  At my 20-week ultrasound, the cysts had disappeared and we learned we were having a second son.

During my second pregnancy, I worked with my doula to prepare for a VBAC, and she suggested also creating a c-section plan and then filing it away in a drawer.  I did this, making a list of all the things I didn’t get to experience with my first cesarean.  Though I knew that my chances of achieving a VBAC were high, I did realize that I might still be faced with a c-section again.  I also knew that I didn’t want to put my baby or myself in any danger, especially because I had a young son waiting for me at home.  I was his mother, first and foremost, and I had to put his needs over my own desires.  I worried about another marathon labor, and how that would impact my ability to care for two babies.  One of my midwives actually eased my mind by reminding me that I could stop at any time, meaning I had the right to ask for a c-section if my labor went on too long, and by saying that, she helped me see that I was in control, something I never felt during my first son’s birth.

Because of my high-risk issues, my medical providers began advocating for a 39-week induction, and my husband and I resisted this idea for weeks and weeks.  Our son was healthy, according to weekly ultrasounds in the third trimester, and I hoped to go into labor naturally, just as I did during my first pregnancy.  Eventually, after much discussion on both sides, we agreed to an induction the day before my due date.  I was already 4 centimeters dilated by that time, so breaking my water was enough to get active labor started.

This time, my labor was completely textbook, short, and beautiful.  I welcomed my contractions, realized when I was in transition, and pushed with all my might in different positions for two hours.  But my son would just not descend, and I could feel this.  When my doctor mentioned that things seemed to be heading in the same direction as before, I agreed with her and realized that I was going to have a CBAC.  I remember telling my husband, “You know what to do,” as he was handed scrubs and I was wheeled to the operating room.  My labor nurse stayed with me as the spinal was placed, reassuring me, as I struggled through contractions, that we were about to have a birthday and, “next year, there will be cake.”

After a few moments, my doctor told my husband to stand up and allowed him to film our son leaving my body, so I got to see it on video later.  As she pulled him out, my doctor called our son by his name, welcoming him into the world.  When he was weighed a few minutes later, my husband announced his weight, and everyone in the operating room broke into cheers and laughter.  My husband stood by my side for a long time, holding our baby in his arms, and though he was not born vaginally, I had tried my hardest, and it was a wonderful experience.  Our little family spent hours cuddling and nursing in recovery, and the nurses gave us the privacy that we so desperately needed. Later, my postpartum nurse, who was also pregnant, told me how sorry she was that I didn’t get my VBAC, and I reassured her that it had been an amazing birth.

I had some complications with my incision that caused more pain than I experienced with my first cesarean, but this time, my heart was light and free.  I had worked extremely hard and fought for the best birth for my baby, however it turned out, and in the end, that was exactly what I got.  I felt that rush of pure joy that mothers are supposed to feel after birth, and I was Earth Mother, tandem nursing my newborn and my toddler.  My precious second son, the icing on the cake and the period at the end of our family’s sentence, was finally here, healthy and happy, and I was healed forever.

Sure, I sometimes get a moment of doubt and wonder if things could have been different, but it’s not that painful ache that lasted for months after my first son’s birth.  I gave away my maternity clothes once I stopped wearing them, shedding only a few tears, and as my baby, who is now 13 months, ages out of his clothing and gear, I joyfully donate things to friends and charities, looking forward to the next stage in his life.  I congratulate my pregnant friends and empathize with their discomforts, all the while knowing that I will never again carry a child inside me.  My baby is a mama’s boy, the complete opposite of  my first son, and I revel in this, realizing that I will never nurse another child after him.  I will never have a vaginal birth, and that is okay, too.  It took me a long time to get to that point, and to be able to say it without tears, but I am there now.  I realize that my experience is simply that, my own, but I hope it can be of some comfort to other CBAC moms.  I am looking forward to life with two active boys, and I have no regrets.

I never imagined, when this journey started, that it would begin and end with a cesarean section, but that’s how it turned out, and I am stronger for it.

A few sources that really helped me process my first c-section and my CBAC include:

ICAN’s White Papers

Ended Beginnings: Healing Childbearing Losses by Claudia Panuthos and Catherine Romeo, 1984

“Having a Cesarean-in-Awareness” by Virginia Bobro and Donna Moore

http://www.birthingfromwithin.com/cesarean



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