5 Things I wished I’d know before my c-section (and VBAC)

Today is the last day of Cesarean Awareness Month, something I would not have expected would apply to me when I first got pregnant a little more than 10 years ago. But it does. After my 2006 c-section, I went on to have a homebirth with my second child, thanks in no small part to the support of the very group I assumed I would never attend: the local International Cesarean Awareness Network chapter, ICAN of Nova.

I wish more people checked out ICAN early in their pregnancies and thought through all the things that can influence birth. My c-section in March 2006 was not a traumatic, emergency or unnecessary surgery; I truly believe that his short cord would have prevented him from being born safely vaginally. And I didn’t have a repeat c-section; I had a vaginal birth after cesarean (VBAC or HBAC,  homebirth in the water that took only 4.5 hours. But there still are a lot of things I wish I’d known, which I’ll share below.

But first, a quick background snapshot:

My son was breech and would not turn despite plenty of chiropractic care, exercises, visualization, acupuncture & moxibustion and finally an attempted external cephalic version. I was transferred out of the care of the birth center and to the only doctor in Northern Virginia who delivered breech babies without hesitation. At 40 weeks, 4 days, my blood pressure was 140/100, and the doctor said I would need to be admitted. I requested for a trial of labor in hopes of a vaginal delivery, but the baby did not descend after several hours on Pitocin.

When I asked to see my placenta after the surgery, I noticed the short cord and eventually talked about it with the doctor. He said that 8″ was about a third the normal length and that, yes, it would have been nearly impossible for the baby to be born safely. This made sense to me and helped me feel a little better. I knew my placenta was high. There just wasn’t enough slack. When I chatted with Ina May Gaskin at a wellness event years later, even she said, “Eight inches!” She agreed that it sounded like I needed a surgical delivery. I felt something akin to being absolved.

Even though I think the ultimate outcome was as good as we could have expected under the circumstances, I still wish the circumstances were different and that my son could have had a normal birth.

Here are the things I wish I would have known.

1. Good digestion is vitally important.

Inflammation is not a good thing at any point but certainly not during pregnancy. And if digestion is poor, nutrient absorption is, too.

I had already figured out that gluten and cow dairy were problems for me a year before conceiving. I wish I’d taken more time to heal my gut and to learn more about anti-inflammatory diets. It wasn’t until I got very ill after my son was born that I talked with a nutritionist friend and confronted the fact that I’d probably had colitis for months. I wish I had been familiar with the Bristol stool scale that shows what poop should look like and sought help earlier on.

Instead, I had to hit a pretty low point to figure out that I needed to eliminate corn and goat cheese from my diet. I looked into the Gut and Psychology Syndrome (GAPS) diet and the Specific Carbohydrate Diet (SCD) and took a little advice but didn’t go full-on.

I’m already a small woman without a ton of room for a growing baby, but I think the inflammation in my gut probably just made it worse. As my midwife for baby #2 explained, if the baby doesn’t move a lot, he won’t grow a long cord. And how can a baby move a lot if the space is too small?

The biggest feeling of guilt comes from the fact that the problem of my poor nutrient absorption and my leaky gut likely affected him throughout pregnancy and nursing, and even today.

2. Babies need a healthy microbiome that they get only from passage through the vagina (or swabbing from the vagina).

Sure, I brought probiotics with me to the hospital. I didn’t eat sugar. I had a sense of the importance of gut flora, but I didn’t know that giving my baby some of my vaginal bacteria could help. Now that he has been suffering from spring allergies for the past several years and has some skin and digestion issues, I wish I could have given him a better start.

Check out these related reports: from WBUR, from Science Nordic, from The Daily Beast and medical journal articles “Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis” and “Cesarean delivery may affect the early biodiversity of intestinal bacteria.”

3. Breech babies need some extra TLC

We were fortunate enough to have a craniosacral therapist present at my son’s birth. Instead of supporting me through my vaginal birth as we’d planned, she videotaped the surgery for us and was witness to the use of forceps at the end of my son’s birth. She thus had a unique perspective on those first outside pressures applied to his head. And having worked on my prenatally, she also knew my body well and understood the pressure on his head that we probably still see the effects of today.

Not only are babies designed to experience the squeezing of their head through the birth canal, they also should spend the last few months in utero head-down, not smooshed up near their mom’s rib cage. Those forces could have contributed to my son’s tightness and strain patterns and possibly to the development of his mouth such that he has tight frenula (which were not diagnosed by a lactation consultant and which likely led to the improper development of his mouth compounded by the genetic information from a father who had a narrow mouth with 8 teeth pulled and braces. Now my son has an ALF orthodontic appliance, which is helping widen his palate to its full potential and, we hope, eliminate or lessen the need for braces.

If I’d fully understood all these pieces when he was a baby, I would have likely clipped his lingual frenulum, which might have helped him nurse more efficiently and thus avoid the need for formula when he was 3, 4 and 5 days old, which would have also kept his gut healthier.

Thankfully, we did know enough to have the craniosacral therapist with us at the birth and to have her work on both me and the baby within an hour of his birth. She told us his “hips did a lot of unwinding,” which took on new meaning for me a few months later when a colleague whose wife had a breech baby talked about the baby wearing a harness. Read Wellness Mama for more on hip dysplasia and watch this video of a craniosacral therapist working on a baby who was breech.

 4. A c-section scar doesn’t have to hurt to be problematic, and it can affect you after a vaginal birth

Once it had healed, my scar didn’t bother me. I got back to running within a few months and had no hip or back pain. My abs got pretty solid again; I didn’t understand how some of my friends looked pregnant years after their babies or why they thought they needed a corset after birth of #2. Abdominal separation didn’t seem to be an issue for me. Not until my subsequent homebirth, that is.

After my daughter was born, I felt kind of, well, broken. The birth was not hard or painful. I didn’t tear. But I felt like I’d been in a car accident, like my pelvis had been crushed. I didn’t want to go for long walks and even after months didn’t feel like jogging. The idea of pounding on pavement just felt wrong.

I had seen several different chiropractors in the 4+ years after my first child and during my pregnancy. Only one had, during a Acugraph scan for acupuncture, commented that my scar was sort of breaking up the flow of energy in my body. So I used a laser some before conceiving my daughter. Then later, I went back to this practice and did some Medi-Body Packs to break up the scar tissue and its energetic residue. (The therapy is explained well by this clinic whose treatment tips I wish I’d known about.) And even before that, just a few months postpartum, a practitioner at that same conference where I met Ina May worked on my scar and it felt a lot better.

Still, I remained in the dark about my abdominal healing and the extent of the problem my scar was causing me years after my HBAC. In those early days, I knew it seemed hard to sit up, but I hadn’t bought or even looked into a girdle and either didn’t hear or absorb from my midwife that I really did have diastasis recti and so did not avoid the kinds of abdominal exercises one should never do with a separation.

Only after I’d started doing them when my daughter was two and then experienced pretty extreme constipation did a practitioner suggest I see a physical therapist. From that PT I learned a lot about how my scar and my abdominal separation were affecting my organs. She did myofascial release and gave me exercises to do. She also cautioned against running until we’d made a lot of progress lest I end up with a prolapse or some other injury that might result from the tightness in my back and hips as a result of my poor abdominal tone.

Two years later, I haven’t been able to prioritize regular exercise or to spend the time or money to see the PT often enough to make a big difference. I’m still trying to figure out what foods are contributing to various symptoms, including psoriasis and fatigue. I miss running and don’t like the look of my belly flub, but I just can’t seem to address it in a concentrated way with everything else I need to take care of.

Seeing that Grassfed Mama is into that Crazy Wrap Thing, I just might check that out!

But even so, I think I really need more hands-on work. I knew I was going to get my period back the first time because my scar and pelvic bones started to ache. That still happens most months. Even if I deal with my flab, there is still something going on there!

5. A little help early on can go a long way

With my history of adrenal weakness, thyroid issues and depression, I really should have put some support measures in place, even though they would have cost money.

If I had to do it all over, I would:

• see that awesome physical therapist (see #4) throughout the pregnancy and after, get a girdle and do exercises to mitigate abdominal separation
• have a babysitter or postpartum doula lined up to help in those first few weeks or even two months so I could rest, cook grain-free or even autoimmune Paleo protocol food, get to appointments without tons of stress, and do what I needed to do to heal and not go down the road of adrenal fatigue
• recuse myself from all volunteer work for five months postpartum and ensure that anything I left to others was easy and already well-planned out
• sleep whenever possible
• never eat after 8 p.m. and get testing to understand why I wasn’t digesting well. Then use digestive enzymes
• have Emotional Freedom Technique sessions lined for the postpartum period so that I could work through issues and not have them become my baby’s issues, too
• consult with experts on the use of flower essences, essential oils and homeopathy for more healing, physical and emotional

And now, I encourage all women I know to see chiropractic care, eat well and to rest as much as possible to help encourage the best possible conditions for birth and recovery.

I also recommend that every expectant mama read info from ICAN and attend a chapter meeting. Thanks to ICAN of NoVA, whose c0-leader has a guest post up today on my DC-area resource site, Mindful Healthy Life.