When I got the call to schedule a repeat C-section for my second baby, I briefly considered hitting ignore. I was sitting in a crowded bakery, trying to get some work done, and the idea of putting this day on the calendar, of semi-committing (“You can always change your mind!” has been everyone’s refrain; mine too) — well, it was a lot. But I took a deep breath and answered the phone. The woman on the line cheerfully asked me to confirm my details, and I answered her questions in a vocal register that got higher and higher so that by the time she asked me when, exactly, I could come in for surgery, I’m guessing only dogs could hear my reply.
“Are you nervous?” she asked. “You sound nervous.”
“Oh!” I said. “Ha. Well …”
Major surgery? Big decision? Meeting my baby for real? Going against the “natural order” of things?
“It’s just funny to pick the date and all,” I said finally. “To know so far ahead of time.”
My first experience with birth was sort of your standard fare of non-tragic hell: one of those wide-eyed attempts at the Perfect Natural Birth Experience where labor lasts 40 hours without real progress and includes a failed epidural, an unplanned C-section, and mild PTSD. I harbored no aspirations toward getting some sort of redo. Birthing-through-the-vag would probably make for a better recovery, and was easier to justify in casual conversation and in personal essays on the internet. But let’s say it was no longer the golden ring.
Still, setting a date was something else. I felt a brief flicker of loss for the romance of mystery — all the wondering, late in pregnancy, if tonight would be the night.
“Oh yes,” the woman on the phone said. “It’s strange, but nice, too! To be able to plan ahead. And pick your baby’s birthday!” She said it in a way that made me suspect she’d been in the situation herself.
It is nice: looking up potential birth charts on astrology websites. Consulting my first son’s school calendar. Knowing exactly when to have family in town. But scheduling the birth, and circumventing labor, did feel like I was getting away with something I shouldn’t. It felt like a sin! Getting a C-section, in general, feels a little like a sin. The difference between my first and my second is that now I can see how ridiculous that feeling is. The difference is I know what I’m getting into, and only give thoughts like that so much credence.
It took a long time to get to this place, though. And it involved — involves — a lot of second-guessing.
When I was on the operating table in 2014, my obstetrician reassured me that she would be birthing my baby through a “low transverse” incision in my uterus, which meant that I’d have a great chance for a low-risk attempt at a vaginal birth next time. In the moment, offering “next time” as some sort of consolation, even considering a next time, felt like an absurdity. But it was something. Amid all the dark feelings of failure that rushed in that first year or so postpartum, whenever I thought about my son’s birth, there was always that small fact: I had the right kind of incision; I could try again next time. Now, I’m not so sure.
At my first OB appointment in 2018, I report this to my new doctor. Low transverse scar, failure to progress. Forty hours of labor, 28 hours at home … never dilated more than five centimeters. I shrug a lot, still, when I try to explain why I got a C-section. “They thought maybe he was stuck? Who knows.”
“How attached are you to a vaginal birth?” she says.
“Not at all!” I insist, and I am surprised by how true it feels in the moment. I tell her, jokingly, that if I could have a straightforward, complication-free, swift vaginal birth after cesarean … “then sure! I mean if it’s easy, why not?” We all chuckle, darkly.
What I don’t say but should is how afraid I am of being broken in a whole new way. What I should be telling her instead of “40 hours, failed epidural, maybe stuck in my pelvis, nobody really knows” is how alone I felt in labor, how helpless; how I still cry sometimes when I think about it. How I was in such pain, yes, but felt exhausted and destroyed on some cellular, some soul level — betrayed, even. What I should tell her is that a few months ago, when we were moving our big green couch into our new house, and my arms felt like they would give out, and my body started to shake, and I was afraid I would drop the couch and it would crush me, I spat out, “I can’t do this!” in desperation, and my husband said, “You can! You have to! You are!” and I fell down and dropped the couch and started hyperventilating. It felt just like being in labor — him encouraging me, me unable to communicate how bad I felt, how close to dropping the couch I was. Dustin set down the couch and I ran inside and sobbed, unable to catch my breath or speak. All of those feelings were all still there, as immediate as they were four years later, right under the surface. A couch.
“I mean, it would be nice to have an easier recovery.” Shrug, shrug, shrug.
The doctor eyes me, some sort of intuition clicking into place. Maybe she sees the way I am clasping my hands together and hunching over, doing what Dustin calls “nun hands.”
“Let’s pull up the calculator,” she suggests to her assistant, a woman who is always there in the room, taking notes so the doctor can focus on actually speaking to me. I feel allied with her, a fellow civilian.
At the mention of the calculator I sit up, brightening. I know about this Calculator because it exists on the internet like a sort of Magic 8 Ball that spits out your chances at a “successful” VBAC. I already know my odds: 42 percent. The factors are age, race, BMI, whether you’ve had a vaginal birth before, the number of C-sections you’ve had, and whether your C-section was performed because of “failure to progress.”
“Forty-two percent,” the doctor says, shrugging. “Less than half.”
“Yeah,” I say, feeling both guilty for being such a disappointment and relieved, like I might be off the hook.
“So we can always try …” she says.
“…Yeah …” I manage. We are now in dangerous territory. What kind of enlightened, Buddhist-level fluency in the practice of nonattachment would it take, to plan and try for a VBAC and then not feel like a failure if it doesn’t work out? When it literally “fails.” I know people do it, but I am not great at doing things halfway, at not-caring.
We talk about risks, about how if I go too far past my due date, I’ll get the C rather than an induction, because medically augmented contractions are stronger, and a uterus with an incision can be too fragile to withstand them. If I go into labor on my own, I’m supposed to come right to the hospital to be monitored. No laboring at home, because my uterus might rupture. She tells us this risk — which, in its worst presentation, means my uterus tearing open like a paper bag and the baby floating in my abdominal cavity as I bleed out and he asphyxiates — is roughly one percent.
“That seems like a lot!” Dustin says.
“I agree!” she says, looking relieved. “And that’s why we would want you at the hospital, okay?”
My obstetrician and I go on to have what feels like a masterfully noncommittal conversation. We level. She says we can play it by ear (play it by cervix?). Maybe come 40 weeks the baby will be locked into position. Maybe my cervix will start “ripening.” Maybe I’ll feel ready. We can schedule a C for 41 weeks, for instance. Give the baby a chance to come on its own. Plus, I can always change my mind.
When Dustin and I go to lunch after, I can’t believe how good I feel, how soothing it is to have a medical provider who will go over worst-case scenarios and statistics and meet me on some middle ground where I don’t have to commit either way. I feel treated like a collaborator, like we are gonna work this shit out, as two smart women, this problem of how to get the baby from inside of me to outside of me. Sure, I haven’t exactly been forthright, but it is hard to know the right time, or if it’s ever the right context.
After my first son’s birth, I saw a therapist. Together, we recognized that my tearful, panicked flashbacks to childbirth might be a form of PTSD. “I think it will fade with time,” I remembered her telling me. “But also leave room for the possibility that it might never be totally resolved.”
Now that I was pregnant again, I decided I’d see her for a few sessions to work on some sort of postpartum mental-health plan. I was hoping to leave with a to-do list. Some coping mechanisms. Maybe a number to call in case what was probably postpartum depression comes back. Mostly I want to feel like I am being proactive; responsible.
What happens instead is she opens our first session with, “Remind me, what was your first birth like again?”
I start to tell her but am taken aback when my voice breaks. And I sob. I tell her that I finally figured out what it was that made it so bad, traumatic, even: It was when the epidural failed and I was stuck in the hospital bed, immobilized and screaming and no one would do anything; everyone insisted it was normal. And intellectually, hey, I guess it was. But that was when I thought I might die, or would prefer to, and when I felt existentially alone, like truly, trust no one, we all die alone, when I found out that people will stand at your hospital bed while you are taken into the darkness and begging for relief and they will say, “You’re okay.”
My therapist gently points out that the trauma is still “very much there.” I can’t help but agree, and feel screwed. I know there is no way I can “fix” this in the few months until I am supposed to do it again.
Casting about, I admit my fantasy: that the baby is breech, and I don’t have to make the decision. Because it seems “bad” to choose what I actually want, the forbidden scheduled repeat C-section. “So maybe that means I should just take the C?” I say, more to myself than to her.
Before this conversation, I felt like I should leave room for the possibility of a VBAC. 42 percent. It would be cheaper. Lower risk overall. Maybe I’d get the good hormones this time? If things went well, maybe I’d be able to get up and walk around after, albeit with a wince, instead of having a catheter and numb legs for a day, and then on Percocet and unable to drive or walk very far or pick up my son for weeks. I figured I shouldn’t rule it out.
But then what if it’s not fine, and I’m traumatized all over again? I still have the same pelvis. The same pain tolerance. The same baggage — even more now. Do I really need all of that reiterated to me, over the course of a few horrible days? What I know now, saying it aloud to my therapist, is that I cannot risk it going that way again. I cannot go through it again. I am not sure what would happen to me, emotionally. Plus, now I know what’s waiting on the other side: No sleep, sore nipples, breastfeeding around the clock, trying to be present for both children. Trying not to hate my husband. Postpartum depression and anxiety right around the corner. I want the baby. I just want the baby.
When I was pregnant the first time, a few well-meaning friends said to me, “Don’t be a hero.” In birth parlance, this means, “Get the epidural.” This only strengthened my resolve. A hero was exactly what I wanted to be, what I felt like I needed to be. Who didn’t want that, I privately thought. I was in the middle of proving myself to myself, then. How could I be someone’s mother, how could I not ruin them, if I couldn’t be heroic? It felt like that would be what was required. It felt like a test. When I failed it, I wasn’t sure what that meant for me, what kind of mother that made me.
What I am interested in now is not a successful anything. What I would like isn’t even even a good birth. I’d be content with a not-awful one. I want to not feel abandoned, unheard, unseen. I have no desire to be brave or “strong.” The idea that I would need to be brave on top of everything else makes me sputter now. What a trap. A trap within a trap! What do you think of when you hear a “strong woman”? I have to admit that now, I think of a sucker. A woman crying silently in the shower.
I don’t believe in the nobility of suffering, not when I really think about it. Maybe there’s something to be gained from it, some self-knowledge, compassion, and so on. But I know I’ll get enough taking care of a newborn. I don’t need extra. In fact, I feel like I need to bank non-suffering just to steel myself for what’s to come. I don’t think that by enduring more pain I will earn a better outcome (though many would argue just that, birth-wise). But I used to think that; I did the first time. Before I was a mother it felt like a Faustian bargain. I wanted to be good.
Before our last session, my therapist offers to write a few bullet points on a Post-it note for me. “Protect sleep” is the first one; another just says “SSRIs” for in case I bottom out again (“Everything is different in your life this time,” she says to me, marveling almost, “but the one thing that isn’t? The fucking hormones”). “Control” is the last one. She means for the birth. It is clear I need to feel a sense of control. But what does that mean?
When I get home, I show the sticky note to Dustin and we laugh and then I cry, saying out loud that I think it means a C, that I think — no, I know — it’s what I want, and that I should pursue it. We have what is maybe the best conversation we have ever had in our eight years together, the sort of conversation that makes you look forward to the rest of your life with someone.
The next time I see my OB, she mentions the birth again, suggesting we need to schedule the C-section soon, the one we can hope I don’t need, if that’s what I want. Her assistant brings out the calculator again. I know it’s time to broach the subject in a real way, in the way my therapist advised. “You should use the word trauma,” she suggested. “How your OB reacts will give you a lot of information.” Partly I’m afraid to find out, because I like my doctor so much.
“Well,” I say, and immediately tear up and start apologizing. I say I talked it over with my therapist, and I had a lot of trauma from my last birth. “Lowercase ptsd is what we’ve called it,” I tell her, taking the Kleenex she’s handing me.
“Okay,” she says, matter-of-fact, almost adamant. “Let’s own that, okay? I see this all the time. It’s very, very common.”
Then I sheepishly confess I just want the C. Preferably at 39 weeks, so I don’t go into labor first. She asks how many more kids I want and I all but shout ZERO, and then she asks how sure I am, like tie-my-tubes sure? And then I sob more, feeling some sort of primal threat.
“Listen,” she tells me, “if you planned to have three more kids, or your last C-section wasn’t because of failure to progress, which is likely to recur, well, we’d be having a different conversation. But it’s a totally reasonable choice. And if it’s what you want? Given your history, I think it makes sense for you. Don’t feel bad about that.”
Then we look at the calendar together, and I can’t believe it. It was all so simple. Someone will call me to schedule in a few days. “So that’s it?” I say, grinning. And then I feel the thing I used to assume other women were pretending to feel: excited to meet my baby.
I am excited to meet my baby. I want to see what he looks like, I want to hold him. I want the weeks until he comes to go by quickly. I am, for once, not afraid.
Meaghan O’Connell’s book of essays, And Now We Have Everything: On Motherhood Before I Was Ready, comes out Tuesday, April 10.
