Most people who know me know that I’m a huge advocate of natural childbirth options, that I worked at the Florida School of Traditional Midwifery for a few years, and that my first two children – Joshua and Ella – were born in freestanding birth centers with midwives. My dissertation and related publications focus on pregnancy and childbirth, with some emphasis on contrasting the medical and midwives models of care. So when my first pictures on Facebook of baby Auguste were clearly taken in a hospital, I know that a few people are wondering why. So, here is baby Auguste’s birth story.
I planned on giving birth to Auguste at home with Kaleen Richards of Tree of Life Birth and Gynecology, the same midwife who helped me bring Ella into the world. I had the perfect birth planned with all of my carefully chosen support people – Scott, Kaleen, Rebecca Barnes as my doula, and Nichole Robins-Bowling as the caregiver for Ella and Joshua who would help them decide whether or not they wanted to be present. We have a perfect Jacuzzi tub in our bathroom, which is where I hoped to birth Auguste into the world. As my pregnancy unfolded I learned that Auguste had a different plan.
At around 34 weeks, Kaleen identified that Auguste was breech. He was more oblique at this point, lying diagonally across me. I started treatment with Alicia Rivera, a chiropractor who has a very high success rate with turning breech babies, and it worked. By my 36 week appointment, Auguste was head down and I was one centimeter dilated. At 37 weeks he was still head down, but by 38 weeks he had turned back to breech. I resumed my chiropractic treatment and started every other non-medical treatment available– acupuncture, moxibustion (burning herb sticks on my toes), hypnobirthing, talking to Auguste, flips in the pool, frontward rolls off the couch, homeopathics, and Chinese herbs. As time passed and the techniques were not working, I knew my chances of the natural homebirth I was planning were growing smaller and smaller.
The next three weeks were not easy, to say the least. I continued the treatments, hoping and hoping that something would make Auguste turn. He was still very high, not engaged in my pelvis at all. Every time I woke in the night I would feel his position, hoping he had turned. Night after night, and morning after morning, I felt his head near my chest. As time passed, we all knew my options were running out. I mourned the loss of the birth I had planned and tried to start preparing myself for a cesarean birth. The whole time I still held out hope that Auguste would turn at the last minute, and once he was head down I would go into labor. Since Joshua was about 43 weeks at birth and Ella was non-medically induced at 42, I continued believing that Auguste simply wasn’t ready yet and that when he was ready he would turn head down and come out.
At almost 41 weeks we met with an obstetrician who was willing to try a version procedure, which manually moves the baby into a head-down position. We wanted to know what his parameters were, hoping that if the procedure was successful we could go home, wait for labor to begin, and resume our original plan of a homebirth. He was not comfortable with this idea since there were too many risks involved, and, as we expected, said that if the procedure was not successful that he would perform a cesarean immediately. When we asked more details about the cesarean, he said the hospital protocol where he works is to take the baby to the nursery immediately after delivery for about 20 minutes while the mom is being repaired, and that skin-to-skin contact would not be permitted until I was in the recovery room. He also told us, when asked, that his success rate with versions at 37 weeks was 0. I was glad that he was honest with me, but left feeling totally defeated and sobbed the entire way home.
By this point, I knew a cesarean birth was the likely outcome. A part of me still held out hope that Auguste would turn at the last minute, but more than that, if I were to have a cesarean, I wanted it to be because Auguste indicated that he needed it. I wanted to go into labor on my own and then have a cesarean if he was still breech. I didn’t want to have to schedule a cesarean because of hospital protocols or political decisions. I wanted Auguste to indicate to me that this is what he needed. But I knew that because my pregnancies tend to go so late that waiting until labor began on its own may not be an option either.
After our appointment with the obstetrician, we went home and had family time in the pool. I took my herbs and homeopathics, burned my last set of moxa sticks on my toes, and did flips in the pool, trying still to get Auguste to turn. We made dinner and dessert and proceeded with our evening as usual. Around 10:30 I got up to get a glass of water. When I returned to the family room, I was standing talking to Joshua, and my water broke.
At this point, I was excited and ready. Auguste was still breech, but he had determined that he was ready. We called Kaleen, made arrangements for Joshua and Ella, packed up some stuff and got ready to go to Florida Hospital Altamonte (a different hospital than the one we discussed earlier with the OB).
Kaleen prepared us for some uncertainty about how we might be responded to in the hospital – I was a 40+ week breech, walking into the hospital in the middle of the night, needing a doctor who never met me to get out of bed and come in for a cesarean birth. We knew that we may not be responded to very well. As it turned out, everyone we worked with was incredibly nice and did everything they could to make our experience as close to what we wanted as possible.
We arrived around 11:30 and met Kaleen in the parking lot. She guided us in and explained our situation for us. The nurse verified that Auguste was still breech, and not engaged in my pelvis at all. She completed the intake and called the obstetrician, Dr. Lopez-Cintron, who indicated that he wanted to perform the cesarean that night rather than wait until the morning. The nurse explained that things would start happening quickly now and that he would be there in about an hour to perform the surgery. Another nurse came in and inserted the IV. At this point, the realization that I was definitely having a cesarean birth was setting in, and I started crying. Scott comforted me and the nurse came back who had inserted the IV. She said they all understood that this was not the method of delivery that I was hoping for, but they would do everything they could to keep the birth experience as close to what I wanted as possible. Throughout the next hour, Kaleen continued making requests to the different people who were involved in my care, advocating for the things we said we wanted if we had a cesarean. Each person indicated that they knew this wasn’t the kind of birth I had wanted, and they would do everything they could to make it a positive experience. Then the doctor came in to introduce himself and explain the procedure. He was very nice and upbeat, even joking a bit with everyone. The mood was light and happy, which made me feel more at ease and excited to meet my baby.
A few minutes later we moved to the operating room. Scott was not allowed to come in until everything was set up, but Kaleen was able to be with me. When I walked into the operating room, it all became even more real – bright lights, lots of equipment, and an array of different people who I didn’t know. It was quite the opposite of the nice, dimly lit bathroom I had envisioned, and I cried again. Kaleen comforted me and reminded me to use the hypnobirthing techniques I had practiced in preparation for my birth. I again relaxed and the anesthesiologist gave me the spinal, which made me numb from just under my chest down, but still allowed me to be completely alert and aware.
Once everything was set up, Scott was brought back into the room. The procedure began, which felt like a little bit of pulling and tugging, but no pain. I hypnobirthed through the procedure to stay calm, knowing this was best for myself and my baby. Scott rubbed my head and told me it was okay. Within a couple of minutes one of the nurses pulled a mirror over and asked if I wanted to see Auguste being born. I didn’t, because I wasn’t sure how that image would sit with me later. I asked Scott to look over the curtain and he did. The doctor even encouraged Scott to take pictures, which I was happy to see later. Within a minute, I heard Auguste cry. I said I wanted to see him, and the nurses quickly lowered the curtain so I could. I instinctively reached over the curtain and touched him. We were informed ahead of time that immediately after birth Auguste would have a little bit of work done to clean out his lungs and make sure he was okay, and then he would be given to me as soon as possible. The nurse again moved the curtain so we could see him as he was being worked on. I assume that this was the time that I was being stitched, but I was focused on Auguste.
Within a few minutes, Auguste was laid on my chest for skin-to-skin contact. He laid on me and looked straight into my eyes while I rubbed on his back. It was a magical moment I will never forget. Then Kaleen helped him latch onto my breast and I nursed him on the operating table – something I was later told the nurses had never seen before.
within 8 minutes of birth
Despite my feelings leading up to it, Auguste’s birth was beautiful and amazing and I wouldn’t change anything. He determined how and when he would be born, and I feel so lucky that I was able to protect him so that he was allowed to decide. The doctors and nurses at Florida Hospital gave us everything we asked for and more to facilitate early bonding and breastfeeding . They offered for us to see and photograph the birth if we wanted to, let us see Auguste immediately, gave him to me to hold, bond and breastfeed as soon as possible, let us keep him by our side and cosleep throughout the entire hospital stay, and allowed us to go home as quickly after the birth as possible. Other decisions we made to facilitate bonding and breastfeeding were to have a spinal or epidural only so that I would be awake, alert and ready to bond and comfort him as soon after the birth as possible, and to take only ibuprofen after the birth so that he and I would not be groggy from the use of Percocet which can make breastfeeding more difficult. Kaleen was amazing at advocating what we wanted and for initiating breastfeeding.
The most important lesson I learned from the experience is what Kaleen tried to tell me a few weeks ago: A cesarean birth can be beautiful and amazing – it’s birth. Auguste’s birth was truly beautiful, amazing and perfect.
Breastfeeding on the operating table
~ Shannon Carter