With her hands comfortably across her chest and her husband at her side, Alicia Atchison raised her head slightly and witnessed the birth of her second child, a beautiful girl named Fiona.
Honestly, she had hoped to deliver Fiona naturally, not by cesarean section. She’d delivered her first child, Miles, by C-section and had mourned not being able to deliver him vaginally — until the moment she delivered her second.
In the operating room, through a clear drape, she watched as her precious little girl took one of her first breaths and the umbilical cord that connected them was cut. Then, Fiona was carefully placed on her chest, and not taken away to be cleaned as Miles was.
“Within two minutes of her birth, she was on my chest,” Atchison said. “I got to soothe her cries and rub her little purple body into life. I will cherish this moment in my memory forever.”
A broken heart
For the birth of her first child, Atchinson envisioned no drugs, low light, classical music playing and only a few important people surrounding her.
For Miles’ birth, she had a doula and a three-page “birth plan,” which included all the details she’d learned from her birthing class where she was encouraged to have an all-natural birth.
What happened, though, was much different. After more than three long days of non-progressive labor, a handful of interventions and labor-inducing drugs, Atchison found herself half-delusional on an operating table, her arms spread and a curtain between her and her baby.
“I was conscious, but I was not present,” she said. “I felt entirely disconnected from what was happening to me. I was lost in grief. In the end, I had a large, healthy baby boy and an easy recovery, but it was still traumatic. It wasn’t what I had planned. I was devastated.”
The experience left her depressed and angry, and she carried those feelings with her and feared another traumatic birth experience when she became pregnant with her second child.
The C-section experience
Once a physician decides a child should be born by cesarean delivery, things move quickly, said Dr. J. Bradley Stern, OB-GYN and UCHealth’s medical director and quality chair of Women’s and Pediatric Care in northern Colorado.
“It’s not wrong. It’s just the way the process plays out,” he said. “C-sections feel rushed for patients because the patient has been there often for hours, possibly days, and then within 30 minutes they are moved to the operating room to deliver their baby.
“The perception of the patient is different from that of the provider, and we try to be sensitive to that by slowing down and listening. But in the end, when the decision is made to have surgery, it’s going to feel like things are going really fast — though in actuality we are just being efficient. But it can be hard on the patients.”
In the past few years, UCHealth has adopted baby-friendly practices for families whose moms have a C-section. This includes: delayed cord clamping, support people by the mom’s side, keeping family members together, allowing for personal touches like music or a clear drape to see the birth, and the first hour dedicated to skin-to-skin time and breastfeeding between mom and baby.
“C-sections aren’t typically planned, so there is a lot going on quickly, but we want both parents to still feel like they are in control,” said Laura Hall, clinical director for Women’s Care in northern Colorado. “We do everything we can to normalize that process and keep that family together.”
VBAC: vaginal birth after C-section
When Atchison got pregnant with her second child, she was determined to have a Vaginal Birth after C-section.
Historically, women were not encouraged to have a natural birth after a cesarean delivery because of the risk of the uterus rupturing along the previous incision. But practices have changed over the years, and for women who qualify, success rates for a VBAC are between 60 and 80 percent, according to the American College of Obstetricians and Gynecologists’ October 2017 press release.
Atchison’s doctors said she was a good candidate, and she’d had a very healthy pregnancy. She continued to work out five to six times a week, saw a Webster-certified chiropractor and did acupuncture. She was eating six dates a day and drinking gallons of red raspberry leaf tea. She was pouring money into anything she thought might help.
“I did more squats than any sane person ever should, and none of it did anything for me,” she said. “My baby would not move down to engage in my pelvis.”
Facing another C-section
For the health of mom and baby, a doctor advised Atchison to have a C-section. She scheduled it for the last possible day that doctors would allow, just shy of 41 weeks gestation. Looking back, she realizes a lot of her emotional drive was coming from pregnancy hormones, but her desire to be a VBAC success story was fierce. And as the C-section date approached, Atchison became more depressed.
On Feb. 11, Atchison and her husband arrived at the hospital at 7 a.m. for her 9 a.m. C-section. Just as she had the last time, she brought with her a “birth plan” — this time it only contained four lines. She wanted her hands at her chest during the procedure. She wanted a clear drape so she could see her baby. She wanted her husband to cut the cord. And she wanted her baby to be put on her chest as soon as possible.
“The morning of the C-section I was numb. There were no tears left,” Atchison said. “I was ready to be done, and there wasn’t anything that was going to make this OK. But I was wrong.”
A different experience: The gentle C-section
At UCHealth Poudre Valley Hospital, each member of Atchison’s care team came into her room to discuss what would happen next.
“Despite my horrible attitude, they listened,” Atchison said. “They were nice and gentle. They held my hand and were so personal. They listened, and they heard me.”
They went over her list of requests and could meet all of them except for allowing her husband to cut the cord because of the sterile environment demanded of an operating room. But he would be by her side, and soon so would Fiona.
The prep went quickly, Atchison recalled. They cut through her scar tissue from the previous C-section, and before she knew it, they were working to pull Fiona out.
“It turned out she was a big baby, and she was wedged inside of me,” Atchison said. “It took both doctors and the vacuum to get her out. I was relieved to know that in all likelihood she would have never dropped, and never made it through my pelvis. This surgery had been necessary after all.”
The highest stress for the patient and family during a C-section occurs when the patient is taken into the operating room, Stern said. But once that baby is delivered healthy, things quiet down.
C-section 2.0
Historically, the baby was removed from the OR after a C-section birth, and a team of nurses would care for the newborn and perform a list of assessments, Hall said.
“We felt that separating the family was not ideal at all,” she said. “Now we have a baby admit nurse, and as long as the baby is stable, we keep them in the operating room and transfer them with the mother.”
C-section newborns are now held next to mom’s face — cheek to cheek — by the support person, and in many cases, stays there in the operating room. Then the family goes into the post-operating room together, where skin-to-skin time can begin immediately.
“That one hour of uninterrupted skin-to-skin helps with bonding, temperature control and breastfeeding,” Hall said. “All assessments are done while the baby is on mom’s chest and skin-to-skin with mom.”
Mom is monitored for about an hour, and then the family is transferred to their recovery room.
Talk it out beforehand
To help ensure a positive experience no matter what situation may arise during delivery, nurses go over the patient’s birthing preferences during a hospital preadmissions visit.
Preadmission visits are recommended at least four weeks prior to the baby’s due date. They provide an opportunity for the family to complete necessary paperwork ahead of time, such as insurance forms, and family and medication history. Patients also have the opportunity at the visit to ask questions and share their preferences for their delivery and hospital stay.
“Most people don’t anticipate a C-section, but preadmission visits would be an excellent time to discuss their preference if it were to happen,” she said. “C-sections can be fast, but we try to accommodate all their wishes. There are things like lights that are not negotiable, but we’ve had people request that their voice is the first one the baby hears, and we try to honor those things as much as we can.”
That philosophy is what made the difference for Atchison.
“I was breastfeeding (Fiona) at under an hour old — an experience I never expected to have with a C-section,” Atchison said. “I looked down at this new face … and I felt overwhelming love, peace and understanding. My daughter would have never made it vaginally. That’s why she wouldn’t move down to engage in my pelvis. She arrived the only way she could, and it wasn’t traumatic, it was gentle.
“My heart had been instantly healed by this experience. I felt completely better, happy and totally at peace, not just with this C-section but also with my first, somehow. My heart swelled with gratitude for the incredible team of women who honored my wishes and followed through to make this birth all the happiness that it was meant to be.
“In the end, this C-section turned out to be what I needed, and more than I ever expected. Every time I look at my daughter, I know that she was sent to me in this way to heal my heart.”