By Rebekah Otto
My daughter was just over two when I got pregnant for a second time. Supported by a great prenatal practice with Barefoot Yoga in Oakland and a local doula group, I had a healthy and smooth pregnancy with her.
My labor started about a week past term. After a full labor and four hours of pushing, she was delivered via c-section. We had skin-to-skin in the operating room, and after my surgery, she latched easily. But in the early weeks of her life, I struggled with shame and feelings of failure—on top of regular ol’ baby blues. Some serious crying and talking to other moms got me through.
In telling that story, I often breezed over the fact that I hemorrhaged 2 liters of blood and my c-section took over three hours as my doctors followed strict protocols before closing me up. I didn’t have a blood transfusion, but my surgical team tied off an artery to my uterus to make the bleeding stop.
I gave birth at a hospital that is part of the Maternal Quality Care Collaborative in California. At the time, I took this for granted as I healed quickly and considered whether to attempt a vaginal birth after c-section (VBAC) for a future pregnancy, which my doctors encouraged me to do.
For my second pregnancy, I wasn’t blindly determined to have a VBAC. Based on my age, the reason for my other c-section and other factors, my likelihood of delivering vaginally was 57%. If labor started spontaneously before his due date, my odds were a bit better. So I scheduled a c-section for five days after his due date and prepared for a vaginal birth, too.
I ate dates, drank red raspberry leaf tea, packed a hospital bag, prepped labor coping plans with my husband. We learned specific coping methods from Nurture by Erica Chidi Cohen, like a visualization that resonated with me, a pressure point on my foot and a double hip squeeze with a scarf. Then we practiced. We did the rebozo thing at home. He massaged my foot so he could find that pressure point. He read the visualization to me.
We joked—I wasn’t going to have 57% of a vaginal birth, so I had to prepare totally for that outcome while not berating myself if I had another c-section.
One of the best decisions we made was to take the online VBAC class from Lamaze. The class gave us a worksheet of questions to ask each other that helped us move from fear and shame to acceptance and optimism.
I don’t know if it was the tea or the dates or just this baby, but I went into labor a week early. I had been feeling contractions for a few days and in the middle of a Sunday afternoon, I knew we were heading to the hospital soon.
5:00 PM My husband and I left for the hospital. When we got there, a resident “checked me” and I was 4cm dilated and 70% effaced.
There weren’t any available laboring rooms, so they kept us in a private triage room. This room was an unexpected gift. The previous family had left on the TV. (It never would’ve occurred to me to turn on the TV.) We flipped channels as my contractions started to escalate, and stumbled on BBC’s Blue Planet, the documentary about life under the ocean. I watched whales jump from the sea, crazy squids swim around and coral, peaceful as can be.
We stayed there for two calm hours. My husband had made photocopies from my pregnancy book (we called them our zines), so he pulled them out to make suggestions to keep me up and moving and lead my visualization.
7:00 PM When we got to the labor room, I went into the shower for some water therapy. The warm shower calmed my contractions and helped push me forward, and I asked the nurse for nitrous oxide, a newer labor coping option.
Once I got the nitrous, I got out of the shower and relaxed into my hospital bed. It took me a few tries to get the hang of the nitrous machine while my contractions were very, very, very intense. (I had to breathe in really deeply and keep the mask tighter to my face than I’d thought.)
Like many women, I threw up a lot during labor. Throwing up often came with a big labor event, though, like my bloody show or my water breaking. It felt like my digestive system was saying: you’re on the right track!
9:00 PM I wanted to get checked to see if I was beyond 6cm, which was when I wanted to have my epidural placed. I was 7cm, so they called the anesthesiologist. The half-hour wait was very intense, almost transition labor, and I was very grateful when she finally arrived.
12:00 AM I was fully dilated and ready to start pushing.
My nurse said she’d help me with “practice pushes,” which were turning into actual pushes. The protocol at my hospital is to place a low dose epidural, so I could feel the pressure of the descending baby.
1:30 AM The nurse moved a mirror so I could see the work the pushes were doing, and she had me put my hand on his head as he started to crown. She and my husband coached my pushes with counting and breathing guidance. My baby was born sunnyside up, or “facing the stars” as the midwife said. He was warm, screaming and bloody on my chest, latched right away, and I was so happy!
Despite my mood, my body wasn’t cooperating. After an hour, my placenta would still not detach. After a manual removal, the ultrasound still showed some attached placenta. I was also losing a lot of blood (again).
They’d tried to stop the bleeding with drugs and a Balki balloon, which puts pressure on the blood vessels by expanding inside my uterus. When those didn’t work, they moved me to the operating room to do a vacuum procedure to remove the rest. These are the standard postpartum hemorrhage protocols that my hospital follows.
My first birth taught me how to advocate for myself in the OR. I was awake and asked for anti-nausea meds or warm blankets, chit chatted with the nurses and anesthesiologists, and even cracked jokes.
4:00 AM The attending physician was worried I had placenta accreta and would need a hysterectomy. So she called in the on-call doctor, who I remembered from my first c-section. The on-call doctor woke up, came in, and said I did not have accreta; they should do the repairs from the tears from birth and send me on my way. (I had a lot of tears because he was sunnyside up.)
By this time, I’d lost 4 liters of blood. (For reference, the average adult has 5-6 liters.) I had received a transfusion and would get more blood and “blood products” before I left two days later.
Retained placentas—and resulting hemorrhages and infections—are the leading cause of maternal mortality in the developing world. “Maternal mortality” is an opaque phrase that means women dying.
I am grateful to my husband, my doctors and my babies. I am also grateful to the team of OBs and hospital staff who started the Maternal Quality Care Collaborative back in 2006. When I see articles about the high rates of women dying, or nearly dying, during childbirth, I know that could’ve been me—if not for them.
When I was pregnant the first time, I thought the big divide in birth was between vaginal and c-section. Now I realize it’s much bigger than that. It’s between life and death. Between women who are lucky enough to get the kind of care they want and need and women who aren’t.
About the Author
Rebekah Otto is the Editor-in-Chief at Babylist, one of the largest baby registries in the United States. Her team develops helpful content and videos about pregnancy, baby gear and parenting. She lives in Oakland with her husband, three-year old daughter and newborn son.