Number Five

Today I’ll tell the story of birth after cesarean from another perspective.

I was hired by a young Amish family in the summertime of 2006 to serve as midwife for their third baby, their second vaginal birth after cesarean.  Like Ingrid, Rachel had attempted to birth her first baby at home with another local midwife, but also ultimately found herself delivered by c-section.  Unlike Ingrid, however, Rachel and her husband, James, felt very comfortable attempting a VBAC with their next child in the hospital with Dr. Beyer and Sue, and they enjoyed success!

By the time Rachel was filling with their third child, she and James were ready to return home.  Rachel and James birthed their next two babies at home with me, the first in February of 2007, and the second in December of 2008.  Each birth story is worth telling, but, for the sake of telling the tale of number five, I’ll leave them for other days.  Suffice it to say that, upon completion of Rachel’s first home VBAC, I could understand why her cesarean had occurred.  With her first, she’d gone three weeks past her baby’s due date, then had pushed against a merely mostly open cervix till it swelled to the point it became an obstacle she couldn’t overcome.  This would prove Rachel’s way, and was something of a difficult way, indeed.

Rachel’s one of those rare women who really and truly carry their babies between 43 and 44 weeks by dates.  When I first saw her, she was 18 weeks by dates, but I knew the moment I laid my hands upon the rounding orb of her womb she couldn’t be 18 weeks.  Over the ensuing weeks her increasing measurements, my ability to hear her baby’s heartbeat with my fetascope, and her quickening – coupled with her history – served to confirm my initial suspicions, so I altered her date to reflect my findings and we carried on.

When, at 43 to 44 weeks gestation by dates, she entered labor, she moved along nicely till 8 to 9 cm dilation.  She began to feel the urge to push then and, instead of her gentle efforts helping the last of her cervix to melt away into the body of her uterus, it began to swell.  As she was unable to resist the urge to push, I did my best to press that lip of cervix out of her way while my apprentice administered alternating doses of homeopathic arnica and gelsemium.  After thirty minutes, with us both sweating and groaning and pushing, the lip slipped back and the child slipped forth – and my arm and chest ached for two days!

This was repeated at Rachel’s next birth, basically from due dates to ache.

Rachel became pregnant again in 2009, and, though her dates predicted she’d birth the first week of April, I guessed she’d birth around the first of May.

Women are women, and bodies are bodies, certainly.  But there are some things unique to working among the Amish.  One of those uniquenesses I touched upon in my story, The Life of an Amishwoman.  An English woman, or Englischer, as the Amish say, who carries and bears many children, does so by choice.  Amishwomen have no choice.  They treasure their many little ones, but their many little ones are thrust upon them, so to speak, and usually a bit more frequently than they’re fully prepared for.  They treasure their many little ones, but they dread their labors in a way I’ve only seen among the Amish.  That dread begins to steal over them around the time of their third or fourth births, and grows with each birth following.  And we, midwives, spend a good deal of our time with older Amishwomen addressing that dread.

Rachel was no different.  Her dread began to manifest as we rounded the corner into the new year, and it grew and grew from there.  Then one night in early April, she had an hour or two of warm-up contractions that sent her over the edge.  Her husband called me early in the morning, “Kim, can you come down here?  Rachel wants me to take her to the hospital!”

I was already in the car, so I just drove right down.  James met me at the door and ushered me in to the kitchen table where Rachel sat with her head in her hands.  “Kim,” she said, “I just can’t do this again!  Last night was awful and it wasn’t even serious and I can’t do it!  Can you take me to the hospital?  I want this over with, Kim!  I want an induction and an epidural!”

As gently as I could, I reminded her that, besides the fact I was certain her baby wasn’t ready to come, she was a VBAC mom, and at that time there wasn’t a single hospital in our area that allowed for VBAC birth.  “But, Kim!” she nearly wailed, “Please!  I’m telling you, I can’t do this!  Will you please check around?  Will you call around to the hospitals and just ask if anybody’d induce me and give me an epidural?”

So, I went to the car and called every last hospital within an hour of Rachel’s home, both in Michigan and in Indiana.  I didn’t even ask after the induction and the epidural, I just asked each in turn if they’d be willing to allow this woman – this woman who’d already successfully birthed three babies vaginally after her initial cesarean – to labor and birth her newest baby with them.  And every single one said no, though all said they’d welcome her for a repeat c-section.

I went back into the house.  Rachel burst into tears.  “You’re saying I either have to do this again without an epidural, or I have to have another c-section?  Nothing in between?”  And she cried and cried and cried while her husband held her hand and while I knelt beside her and rubbed her back.  “I guess I’ll just wait for labor then,” she said when she’d spent her tears.  “I guess I’ll just have to do it again.”  We talked awhile yet before I hugged her and left, but I’d scarcely pulled into my driveway before James called to summon me southward again.

“Something isn’t right, Kim,” Rachel said when I re-entered her kitchen, “something’s wrong, and I want to go to the hospital.”

James was clearly upset, and I knew he wanted me to find a way to keep her at home, but all I could say was, “Okay, Rachel, let’s go.  Everything’s okay as far as I can see, but if you really feel something’s wrong, I’ll take you to the hospital.”

“I just want to go and make sure everything’s alright, Kim.”

“Okay,” I said, “let’s do that.”

We drove to a hospital in northern Indiana that my Amish clients preferred to use when possible, and got Rachel checked in.  I went over her records with the staff, and then with the doctor when he came to see her.  The doctor ordered blood work and performed an ultrasound, and really took his time examining Rachel and her baby.

“Mrs. Bontrager,” he said, smiling, “everything looks good, and, though we don’t recommend or allow VBAC birth here, nor do we condone homebirth, I can’t see any reason you can’t go back home with your midwife.”

“What if I want a c-section?”  Rachel said.

The doctor was visibly surprised, as was James.  “Again, Mrs. Bontrager, we don’t recommend or allow VBAC birth here, and we don’t recommend homebirth either, but there isn’t any reason for you to have a cesarean section today.  You really could go on home with your midwife now, and have your baby with her when your labor starts.”

“Kim,” Rachel said, turning to me, “if I have a c-section, will you stay until it’s over?”

“Of course I will, Rachel,” I said.

“Then I want one.”

The tiny, noticeably early baby girl was born within the hour.  I stayed till they’d nursed well and were preparing to rest.  When I asked what they planned to name the little thing, Rachel said, “Well, Kim, what’s your middle name?”  And she burst again into tears.

Rachel and Ann returned home a couple days later, and I resumed care though, when James handed me a check for my fee I told him I didn’t want it.  “No, Kim.  Ann’s birth didn’t go how either of us thought it would, but you’ve earned your keep.”

Rachel has chosen to birth the babies following Ann by cesarean section, though she keeps in contact with me still, even here in Colorado.

I was sad when Rachel decided to birth Ann in the hospital instead of at home, to be sure, but I was saddened further, and even angered, that the failure of our medical system to provide Rachel the choices due her forced her into selecting a substandard one.

I tell this story to illustrate the rough spot birthing moms of our strange era find themselves in.  One-third of women birthing in hospitals will birth by cesarean section, in spite of the increased and significant risks cesarean birth poses to both mothers and babies.  That number’s ten times higher than birth at home with midwives, but only 2 to 4% of women chose to birth at home.  And, though an attempt at vaginal birth after having birthed by cesarean is clearly safe and preferable to repeat surgery in the vast majority of cases, it still is frowned upon and disallowed by huge numbers of doctors and hospitals, to the point that only 10% of women accomplish VBAC birth!  And the further insanity in all this is – if a 33% cesarean rate isn’t insanity enough – though VBAC birth at home is also clearly safe and more successful even than VBAC birth in the hospital, the American College of Obstetrics and Gynecology is actively attempting to ban HVBAC birth in general, and, specifically this very week, in Colorado.

As ever, all names have been changed.

All photos taken by Kim Woodard Osterholzer

Thank you so much for the gift of your time!

If you enjoyed this article, let’s stay connected! I welcome you to subscribe to my blog, and to join in the conversation by commenting below! And be sure to poke around here a bit, as there are lots more stories awaiting you.

Kim Woodard Osterholzer, Colorado Springs Homebirth Midwife and Author

Books by Kim:

Homebirth: Safe & Sacred

Homebirth: Commonly Asked Questions

A Midwife in Amish Country: Celebrating God’s Gift of Life

Nourish + Thrive: Happy, Healthy Childbearing

One Little Life at a Time: Recommendations + Record Keeping for Aspiring Homebirth Midwives