In the months following my unanticipated c-section, I began to relive the chain of events that led to it. I was obsessed with a need to pinpoint the moment where things started to go “wrong.” Was it when a midwife broke my water to “speed things up”? Or when I chose to stay in the hospital rather than go home after I was decreed to have officially gone into labor on my own, no longer requiring induction for my “post-dates” (41-week-five-day) pregnancy? Or further back, when I ignored my instinctive desire for a home birth and yielded to my husband’s request?
With a healthy pregnancy and no complications, I couldn’t comprehend what had led to my baby requiring extraction via major abdominal surgery rather than emerging from the opening nature designed for this purpose. I felt a deep, abstract sense of incompletion along with a surreal physical urge of still needing to push something out — a phantom baby.
I spent nights on the couch hidden behind my phone, reading up on the controversial practice of AROM (Artificial Rupture of Membranes, aka “breaking the water”) and how “cephalopelvic disproportion,” aka CPD, (baby too big to fit through the pelvis) was far more rare an occurrence than listed on reasons for a c-section, how “failure to progress” can be merely another term for “failure to wait.”
Even my 760-page hospital report did not reveal a concrete answer. (Yes that’s not a typo – it’s 760 pages) “Arrest of dilation at 4cm with adequate contractions on Pitocin,” it reads.
Did Pitocin send the baby into distress? Not an infrequent occurrence, I learned. I’d worked as a fact-checker, a journalist, a writing professor. Curiosity and inquiry were my natural modes. But this was their mean cousin, bullying me in a dark corner. I was channeling my grief into a research wormhole.
Jason, my husband, asked what I was reading.
“Facebook,” I said. Or, “the news.”
I didn’t talk about my feelings of anger and guilt. I definitely didn’t reveal my “research process,” not even to him, my usual confidante from whom I never kept secrets. I’d become a detective on my own sad, private quest for unknowable truth. Also, I felt as though I didn’t have the right to grieve: my string of wrong choices led to the “unnecesarean”.
I blamed my husband, too. My first-choice birth vision took place in a dark forest nestled in a cave surrounded by trees. There are even birth experiences designed for this — in my incessant online deep-dive, I came across a YouTube video of a tub birth in a jungle cave of Paraguay. That’s what I wanted, I thought.
I didn’t want to mention it because I didn’t want to argue (my beloved loves a rigorous debate, even for the sake of playing devil’s advocate) or explain. And I didn’t want to admit one of the reasons I was so upset was that I hadn’t wanted a hospital birth. Hospitals give me anxiety and associations I did not want connected in my mind with childbirth. There has to be another way, I kept thinking. When I made a friend who’d had a home birth, a light illuminated: That was for me. I’d happily go to the hospital for complication or emergency. But I would have a home birth. My intuition, an inner knowing — that little voice inside us all — said this feels right.
But when Jason and I discussed birthing options it didn’t sound right to him. His fear of home birth seemed stronger than mine of hospitals, so I conceded. We’d have a hospital birth, but would hire a doula. In labor, I found myself frustrated that Jason could take a nap on the “partner bed” while I did squats and lunges with our doula, working to get the baby to drop. I wished I’d followed my instincts, but it was too late. I was living out a choice that didn’t feel like mine. The fear-tension-pain cycle is real, and can cause labor to stall, something else I didn’t know until after. Of course, the wild card in all my rationalization is that when it comes to birth, a process not entirely controllable no matter what decisions are made, how do you know?
Still, for months I quietly Googled the night away while the baby nursed and I lied to my husband about my reading material. Trying to pinpoint where I “should have” chosen differently was a cycle incessantly leading back to the same beginning, where it started over.
Being locked in this maddening spiral made me just as crazy as there being no solid answer as to why my body “could not” birth vaginally. I watched videos of 4’11 women pushing out 11-pound babies. Is CPD a myth? Learning more increased my obsession rather than causing it to subside. I finally knew I had to talk about it. As my best friend and the one who’d co-authored the baby and been at the birth, Jason was the obvious choice.
The floodgates opened: I went from keeping my secret to discussing it the same way I “researched”:on a compulsive loop.
“I shouldn’t have let them break my water,” was the point I arrived at again and again when I talked about it to Jason. The baby had been born posterior — facing my belly rather than spine. “She could have been trying to rotate, and they broke it when she was still too high up and got stuck. It was in our birth plan not to do that. Why did they do that?”
And, “If I could do it again, I would have gone home when they first said I could. Staying there too early in labor started the ‘cascade of interventions.’”
Jason couldn’t understand why I was upset, which only upset me more. He’d say things like, “There’s the baby, what more do you want?” And, “I don’t get it at all.” He thought I’d been brainwashed by the pro-unmedicated birth experts at my yoga studio. As much as I explained that no, I chose that training because it validated beliefs I already held, he remained unconvinced.
We argued on and off about it for months. One evening in the Trader Joe’s parking lot, I ran through the events for the thousandth time. Our baby was five or six months old and the birth still replayed in my mind like a movie I couldn’t turn off.
“I just don’t understand why you keep circling around this,” Jason said, correctly insisting there was no way to really know, that even having a concrete answer wouldn’t change what happened. He also couldn’t grasp why I’d wanted a natural birth in the first place. In his view, I attached some sense of “moral superiority” to an unmedicated birth rather than a c-section. To me, it’s all about choice, bodily autonomy, and vaginal birth being healthier for an uncomplicated pregnancy.
“Nature also gives people cancer,” he said.
And, “Nature created smallpox. And bubonic plague. Plus it’s easy to forget how many women and babies used to die in childbirth.”
No denying that, but to say these kinds of comments weren’t helpful would be an understatement. Where I sought comfort, he provided logic.
I didn’t yet know how common my experience was, that you could be happy about the baby while grieving the birth. That PTSD, a term I’d thought reserved for soldiers coming back from war, could also apply to new moms coming home from the hospital with sweet babes. Obsessively reliving the experience was one of the symptoms of postpartum depression.
When our baby was eight months old, I finally sought professional help. My new therapist saw this all the time. She knew what to say (“tell me your story”) and what not to (“nature causes cancer”). She offered helpful exercises, like writing a birth experience with the storyline being how I wanted it to go. In the fictional version, I pushed the baby out in a tub at home, in darkness. Jason was in the tub with me, and one midwife and our doula were by my side, quietly supporting and making sure everything stayed safe.
It ended up looking a lot like how my second birth actually went.
In between my first pregnancy and my second, a home birth midwife in our community opened a freestanding birth center in a house a seven-minute walk from our home, so this was not a home birth, but not the hospital, either. (In case of emergency, it was minutes to transfer.) Because of the obsessive research, I was informed as to the risks and benefits. On reviewing my hospital report, our new midwife confirmed what I’d suspected: it appeared there was no physical reason for a cesarean. My pelvis was not “too small.” “It sounds like you needed more time,” she said. She promised to give that to me, and she did.
During my labor, Jason was in and out of the (darkened) room, caring for our three-year-old rather than in the tub with me–still, an improvement over a nap-induced absence. He said he felt less present, but I felt his presence more. Our midwife and her assistant kept tabs on the baby’s heart rate but I was mostly left to do my own thing in the tub, exactly as I’d envisioned.
On a recent road trip, Jason and I had a longer conversation about my grief over the first birth and how, even after witnessing the second, he still didn’t know why. (When I told him I was writing about it, he said, “Feel free to throw me under the bus for this one.” He’s very understanding about most things.) He began asking speculative questions: What if I’d had my dream birth scenario only to have a complication that led to the same surgical outcome? Or what if I’d had a vaginal birth but with an epidural, would I have been traumatized then? My inclination is to say no; in the first scenario it would have been clear as to why I needed a c-section, and in the second, there’s no surgery — the specific, surprise part of the experience that sent me reeling to understand why it had happened in the first place. But what disturbed me most was the idea that it might have been unnecessary had my choices been different.
My second birth was intense and challenging, but what followed was a sense of triumph rather than a disappointed “healthy mom, healthy baby” (though I was by no means ungrateful for our post-c-section health). With three years’ distance, I get Jason’s lack of understanding. Both sets of post-birth photos show a beaming woman holding a baby. How could he have known the difference, especially since I didn’t express it for several months?
Maybe it isn’t so much “understanding” that I needed from him. Striving to get him to empathize may have been misdirected energy all along. If I could have done one thing differently, I would have asked him to come to the therapist before concluding my care, so he could hear a professional perspective on why I’d felt the way I did, and she have steered us to have productive conversations about birth trauma rather than my compulsive thought loop and Jason’s logical statements.
After my second birth, I realized that knowing both versions made me understand why I’d wanted what I did, even if Jason couldn’t. I could at least know I’d been right: This was the right choice for me, and feeling agency over our choices is perhaps most important for the birthing person. For others, a scheduled c-section is the right choice, or an epidural, or whatever their body calls for. The only superior birth is an individual’s most desirable option or what is medically necessary. To me, it was important to be left to do my thing, rather than have things done to my body. But this, I realized, took time to come out. In times of grief, the truth doesn’t spill out like water; rather, it drips slowly, like honey. Hopefully what lies beyond will be as sweet.