February 17, 2014

Umm 'Eesa on Having an Unplanned Cesarean

Umm 'Eesa is a British-Pakistani mother of two, currently living in the USA. 

What was your original birth plan and expectation heading into labor?
I had the inevitable and unavoidable nervousness approaching my first ever labor but I had had a healthy pregnancy mashaAllah, had done some reading and attended classes so I felt calm and ready for D-Day.  My birth plan was pretty straightforward as the general consensus in the UK advocates for natural, patient lead birthing.  I had specified that I wanted minimal interventions and only when absolutely necessary and that my husband and I be consulted in advance so we could be part of the decision making process.

Tell me about the labor.
My labor started spontaneously at home and progressed well at a steady pace.  I was over half way when I arrived at the hospital and the first midwife I met, read over my birth plan with me.  I had stated that I was willing to take gas and air for pain if I felt I needed it, but wanted to avoid any other medicated pain relief.  

This midwife however explained that having a small frame, the gas and air would likely make me feel nauseous and suggested that I try some breathing techniques to work through the contractions instead.  I HATE vomiting and the thought of it happening during labor was enough to convince me of her strategy!  After a bit of coaching, I was comfortably breathing through contractions (even nodding off in between!) and labor was still progressing well.

It was only once I was fully dilated that things got a little complicated.  I had been pushing for a while and as much as the midwives present were encouraging me (the shift had changed so my original midwife savior had left), they weren’t able to tell me why it didn’t ‘feel’ any different.  I was expecting to feel more pain or change or progression.  Anything to indicate that baby was coming out!  But nothing.  At this point, the midwives monitored me and baby and found baby to be a little stressed so decided to call the consultant to check on me.

At what point did your care givers begin advising that you have a c-section and what were their reasons for advocating it?
The consultant performed a manual examination and found that baby’s head was turned to the side.  She tried manual rotation but that failed so she advised trying a ventouse and/or forceps.  She explained that given some time had passed without any progression and that there was no guarantee other procedures would work, they needed to prep me for a c-section ‘just in case.’   

How did it make you feel to have your caregivers advocating for procedures you didn’t want and were not prepared for?
I knew myself that things didn’t feel quite right and that I needed some sort of help.  Given it was my first labor, I didn’t know what other options I could try, or even existed so the consultant’s plan seemed reasonable.  It definitely wasn’t planned by either party and seeing as all the monitoring, examination and discussion happened in quick succession, within an hour, it immediately felt like an emergency and put me in slight panic mode.

What finally swayed you into accepting the c-section?
I didn’t feel I had any choice.  Nothing else was being offered as an option, baby’s heart rate was abnormal and he had passed meconium. Nothing on my part was changing either and the labor just felt a bit ‘stuck’ so I accepted the c-section assuming it was best for my health and the health of the baby.

What risks did your caregivers disclose to be related to the procedure?
I was aware of the risks from my pre-labor reading, which is why I wanted to avoid it in the first place.  At the time, I was presented with a consent form highlighting the risks and what the procedure involved.  I was talked through it but I only vaguely remember this part.  I was in pain, feeling panicked and had probably abandoned my breathing altogether so I just wanted the next necessary thing to happen without delay.  My husband signed on my behalf.

What sort of thoughts and feelings were going through your mind as you were being prepped for surgery?
I was definitely scared and worried for my baby.  My husband is a very cool cucumber mashaAllah but I could see the concern on his face too.  There was a point where I was wheeled into theater and my husband was sent to change into scrubs so he could be present in the room with me.  Those few minutes were terrifying.  The doctors were prepping me with the spinal, a drip, antibiotics etc. and my husband was nowhere in sight.  That loneliness and having to leave my well-being in the hands of strangers was really uncomfortable but it was my opportunity for dua and there was comfort in placing my dependency in the right place, with Allah.

Tell me about the procedure. 
I was awake during the whole procedure.  Slowly losing sensation in my lower body was a very odd feeling.  I was asked to try wriggling my toes and I remember my husband laughing at me because he said on my face, I was reeeally trying, but obviously to no avail.  I for some unknown reason, asked the doctors to lower the screen so I would be able to see the whole procedure.  They lowered it by an inch, which made no difference at all so I didn’t see a thing but in hindsight, I’m glad I didn’t.  The whole thing ended up being emotionally unsettling as it was so I don’t think adding blood and guts would have done me any favors.  I felt physically comfortable as there was no pain at all but I was still worried and anxious to know how the baby was.  That was the worst part.  I was aware of my own health, could see the monitors beeping, was fully aware of my surroundings etc but didn’t have a clue about that little soul we had been waiting to meet.

My husband was present the whole time, standing by my side.  He could see over the screen and likes to remind me that he’s seen every layer of fat and muscle in me haha.  MashaAllah, he was calm and minimally described the procedure.  He told me after the event that it was stressful to watch and that it looked brutal for both my body, and baby’s but Alhamdulillah, I’m glad he had the sense to not show it at that point. 

What was the recovery period like physically, mentally and emotionally?
Recovery was tough.  Alhamdulillah, I have a decent pain threshold but had never had any kind of surgery before, never broken a bone, never needed stitches so I wasn’t prepared for that kind of physical weakness.  Aside from the regular c-section incision, I ended up needing an additional one as my son’s big ol’ head was well and truly stuck.   That incision caused me some pain for a while afterwards but worse than all of that was some muscle damage in my hip, which I believe was caused by my legs being put in stirrups.  All in all, I didn’t feel physically normal again until 9 months later.  I definitely hadn’t expected that and realized just how much I had taken a healthy body for granted.

The mental and emotional recovery was also difficult.  I had gone into pregnancy and labor, hoping for the best outcome and had no indications to suggest anything but the best.  I was looking forward to labor and can still say that I genuinely enjoyed it Alhamdulillah but when it ended in a c-section, I felt somewhat cheated, like I had lost out.  I remember apologizing to my husband for it afterwards, to which he obviously rolled his eyes but I felt like I’d failed at something that my body was designed to just do.

That feeling stuck with me for a long time afterwards and whilst it didn’t impact my general well-being or my ability to be a mother Alhamdulillah, it did take a while to shake it off.  Its only when I realized that major surgery IS major, that I became more comfortable with it.  If you’re going for a drive somewhere special and are unexpectedly involved in an accident, seriously injured and wheeled into theater to save your life (and an additional life inside of you) you would expect that it might plague you for a while afterwards.  That you might feel nervous, sick, anxious getting into a car again, that you might struggle with the physical consequences of your injuries.  An unplanned c-section is no different and I had to realize that by abandoning my own self imposed expectations of how things ‘should’ have gone and accepting the outcome that Allah had written for me before I had even given motherhood a thought.

My midwife crystallized this for me when she said ‘You don’t get pregnant so you can go through labor.  You get pregnant because you want to be a mother to a healthy child.’  Alhamdulillah, that is exactly what Allah gave me.

How was it trying to bond with your newborn while in recovery?
I loved him instantly, cried for him, worried for him and felt an overwhelming desire to protect him.  I had a difficult start because of the surgery, difficulty with breastfeeding and him being jaundiced at birth and needing treatment for it.  It was stressful and exhausting but that little ruh and amanah from Allah trumped everything.  My husband was with me for all the hospital trips and helped with everything from the get go.  We were staying with my parents at the time so my family was also at hand for anything we needed.  Having all the additional support took away all the external pressures and stressors which meant we could just focus on our new baby.

What sort of criticisms, if any, did you receive from people for accepting a c-section and how did you respond to them?
I didn’t receive criticism per se and I didn’t really talk about the labor unless somebody asked.  People knew it wasn’t planned and mostly focused on my recovery.  The thing that did get to me was that when I talked about enjoying labor (up until the c-section part), some sisters told me that I could only say that because I hadn’t actually labored all the way and that the worst part was dealt with for me.  I didn’t have much of a response for that at the time as it just gave me the sinking feeling of failure again but looking back, I should have put people in their place!  I now know for a fact that natural birth is waayyy less painful than a c-section and that they had no right to judge one outcome to be superior to another when Allah is the decision maker.

Looking back on your experience and knowing what you know now, do you think your caregivers choice to perform a c-section was out of a real medical necessity? Why or why not?
Initially, I had no idea.  Then I went through a phase of thinking they had made an unnecessary decision which affected my physical strength for some time afterwards.  Eventually I came to realize that rightly or wrongly, they made the decision they did, when they thought appropriate and there wasn’t much I could do to change it.  I know my baby and I came out of it alive and healthy and in another time, place and under different circumstances, it could have been a lot worse.  I have since focused on better educating myself about best birthing practices and doing everything I can in terms of exercise and  diet and to prevent the same outcome inshaAllah.  I think it is important to aim for best health but in doing so, not lose sight of the fact that whatever you do, however labor ends up, Allah is in control of that so ultimately, it IS best for you.

How did this experience affect your relationship with Allah?
It definitely strengthened it Alhamdulillah.  I have never been that afraid for my health and never felt so in need of His assistance.  It taught me the meaning of tawakkul.  Even after the surgery, providing for, feeding and nourishing my new baby in the physical and spiritual sense, gave me new perspective on what it is to worship Allah and how hard you have to fight to do it right subhanAllah.  Childbirth and motherhood aren’t just blessed experiences, they’re lessons that never end and a huge test which inshaAllah, bring us closer to Him and His jannah.

What advice do you have for mothers facing unplanned cesareans?
You can’t advise much for the unplanned :p  And to be honest, for all the planning you do, it can still turn out to be the opposite.  I would of course advise doing everything you can to prepare for a healthy pregnancy and labor, not just to avoid a c-section but because our bodies and unborn children have a right over us and we’re accountable for both regardless.  

After that, I would advise to make peace with Allah’s decree.  This has to be done in advance, not after the fact.  My feelings of failure and upset at having a c-section for so long after were due to my not understanding this point.  I thought the alternative was ‘better’ and that I’d fallen short of it whereas in reality, I couldn’t have done better than what Allah had already planned.  We all want health and ease but we should be willing to accept that Allah may test us with both and that our response to that should be the outcome we’re truly concerned about.

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