“It Will Have to be a C-section.”

The Devastating Impact of Unsupportive Providers

I felt the heat in my cheeks as I looked at the doctor. I was in the office for a pregnancy confirmation appointment with my first baby after an emergency cesarean twenty months before, where I received what is known as a special scar. After my daughter’s traumatic delivery and being told I could never have another vaginal birth, I’d spent countless hours processing, grieving, coming to terms with my experience, and finally, educating myself on risks for future pregnancies and deliveries. When we became pregnant again, I was nervous but excited at the chance for shared decision making with my doctors and asked the nurse who checked me in if I could schedule a separate office visit to discuss delivery options.

Immediately outside of my exam room door, I heard three doctors discussing me in urgent and incredulous tones. I vividly remember the words “classical,” “c-section,” “she can’t,” and a random Batman movie quote thrown in. By the time the doctor- we’ll call him Dr. H- entered the room, I was already embarrassed and uncomfortable, but at least somewhat prepared to hear his words.

He went on to talk about me dying, the baby dying, catastrophic complications, and overall that it wasn’t an option to consider anything other than a planned, elective c-section as early as 36 weeks. He said 98% of the doctors in this country would have their back if something went wrong and we decided to sue. After further discussion, he admitted that’s just the way it’s always been done, and he’d never questioned why. I tried to be clear that I was not against a c-section but that I needed to truly believe it was the healthiest decision for me and the baby. I also tried to be clear that I was not advocating for a trial of labor at the time, but I needed it to be part of our conversations.

I maintained my composure, but it was a devastating blow. His response and the responses of the other doctors following my c-section are not unexpected, and are the norm for other women who have non-transverse scars. As much as I thought I’d prepared myself for hearing it, I felt crushed by the way the conversation was handled. I’d never been in a position where I felt unsupported by my doctors or made to feel foolish, but that is how I felt— not like an individual, but a liability. It wasn’t at all handled with the compassion or respect that I expected from their office having already been a patient there for four years and two deliveries.

My next appointment was with one of the midwives and a student nurse. Before the appointment even began, I could again hear the subject of my scar being discussed outside of the room, so as soon as she came in, I told her I heard them talking about it and that the reason it’s so important to me is because I have to be part of decisions in my own medical care.

She was very sweet and respectful and really took the time to listen. She spent over an hour looking through what I’d brought. She had printed information from “Up-to-Date” brought in with certain things hi-lighted, but she stopped reading from it when she made reference to a statistic, and I quickly told her what study it was from. They both seemed impressed with what I had, and by the end of it, she said if it were up to her, she would support me if I came in to the hospital in labor. Unfortunately, it would be up to each doctor.

Reading back over my journal entries from this time, I was reminded how differently I was treated by the nurses I spoke with versus the doctors. Every nurse who took the time to sit down with me and look through information together was thoughtful and respectful, and we were able to look at risks together logically. Not one made me feel foolish, reckless, or uninformed.

One month later, my appointment was with Dr. L, the obstetrician who performed the emergency c-section to deliver my daughter, resulting in an inverted-T incision with a low vertical extension due to her presentation. Again, I heard myself being discussed outside of the exam room, and when the door finally opened, he came in, without making eye contact with me, and leaned against the counter, arms crossed. “All of the doctors here are frustrated with you,” he said. “Discussing your concerns is a waste of time. It has to be a c-section at 36 weeks. You are a ticking time bomb. Your baby could die- or worse, have CP. No one here or at the other hospital will let you labor. If you show up at the hospital in labor, I don’t care if you’re crowning, you will be taken to the OR for a section.”

He then told me I must be “confused” about the type of scar I had and went on to say it was classical all the way up to the fundus and that he had “filleted” my uterus to get my daughter out. I would later learn that he would repeat his exaggeration of my scar to every doctor in the practice and to other nurses. I believe this was in a very successful attempt to prevent me from seeking supportive care anywhere.

I tried multiple times to bring up concerns and was interrupted. When I attempted to raise concerns regarding the risks associated with c-sections, especially multiple c-sections, and he told me I just didn’t need to have any more children. There was no evidence-based discussion of risks. He then condescendingly said he would email me “the latest” information with hi-lights, though I’d already looked through every study I could find with fine-tooth comb, even carefully compiling a folder for my doctors. In response, I was told, the information they had “wasn’t google.” When I responded that mine wasn’t either and was from the ACOG’s current VBAC practice bulletin and published medical journal studies, he didn’t believe me, at one point even saying, “you don’t have access to these- or maybe you do, I don’t know,” in a way that clearly indicated his skepticism. (Spoiler alert: his email to me later included copy/paste statistics from exactly the same ACOG practice bulletin and studies I was quoting from. He refused discussion any discussion at all and said the only thing I would be allowed to talk about in future appointments was timing of delivery.)

He closed his monologue with a comment that he’d received training on not being patronizing and that he was just being pragmatic.

He painted a vividly clear picture of how I could expect to be treated in that hospital system.

Much to my horror, at that point, I cried. How could I trust myself or my baby in the hands of someone like this? If I couldn’t find a doctor to listen to me and talk through my concerns, how could I trust any of them to cut me open?

I finally found more respectful care in Dr. W., who took time at my appointment to listen to what I’d been through and not make excuses for the way I’d been treated. He did, however, make it clear that if I wanted to deliver at either local hospital, I would be required to schedule an early c-section.

The rest of my prenatal visits consisted of more of the same— anxiety on my part, never having the chance to truly discuss my concerns, and doing my best to “put on a good face” and be a “good patient” to avoid mistreatment and schedule an early c-section. At every appointment, I expressed concern over the timing of such an delivery and whether he would be ready, given that all of my babies were 40+ weeks and were told a range of responses from “I’m not worried about that” to “better a NICU baby than a dead baby.”

In the end, I scheduled a repeat c-section at “38 weeks,” feeling as though it was my only “supported” local option. Note: this office determines due dates based on LMP and a 28 day cycle, regardless of a woman’s personal average cycle length or ovulation days. I estimated his gestation to be closer to 36 weeks. Though I tried to mention this at many appointments, I was never heard.

At my final appointment before the scheduled surgery, I was required to sign a consent form, and I attempted to repeat the concerns I’d mentioned at every previous appointment, saying, “I really don’t feel good about signing this.” The doctor’s response was to say that he couldn’t deliver the baby, and left the room. When he came back to retrieve the form and close out the appointment, I heard the nurse outside give a quiet, “yay!” when he came back out with my written consent.

Essentially, I was forced and coerced to schedule surgical intervention that I did not believe I needed and legally accept risks I didn’t truly accept— without having the chance to discuss them with my doctors— and I had to sign a form saying I agreed with it all.

On the day of delivery, I woke up feeling cold and emotionally hollow, but I consoled myself with the knowledge that I would soon be holding my baby in my arms, and everything would be OK.

The cheerfulness of the staff grated on my raw nerves as they checked me in for pre-op. This was a normal day for them. Didn’t they know it was taking every ounce of effort I had to be polite and smile and make myself walk into that sterile operating room? Didn’t they know what it was like to force myself to climb onto that narrow, cold table to allow myself to be cut open? Didn’t they know what it was like to lay there, arms outstretched on a cross and helpless? Didn’t they know?

The atmosphere of the OR was bright, loud, and busy. Everyone was super nice and happy to be there. They were a good team, but I felt like everything was just sort of going on around me, and I wasn’t involved. There was a lot of other conversation going on— how many other laboring moms on the floor would probably end up having a c-section, the “puddle” (mother whose water had already broken) in room 5, someone moving to Chattanooga, and other personal chats. I didn’t feel like it was really about James or his birth, it was “the section in room _.”

Upon later reflection, I realized the operating room had given me a glimpse into how birthing women are viewed as a whole, even in respected hospitals and highly rated Labor and Delivery wards. Women were almost expected to have interventions or even to “fail” at delivery. The idea of a natural birth was laughable as they speculated on who would get an epidural since she was already complaining at a 4. It also occurred to me these conversations only took place in the OR because it was so easy for them to forget that I was even there, even with someone’s hand in my vagina inserting a catheter.

When it was time to begin, I watched the surgery in the reflection of the lights on the ceiling until my baby was out. I’d requested a family-centered cesarean and gave some wishes, but there didn’t seem to be many options other than a clear drape for delivery, which we declined. He came out OK at first, and I was able to awkwardly have a moment of skin-to-skin before he was taken away to be checked out, and my husband was made to leave the room so I was again “alone” in a sea of people in the OR with their conversations about lunch and weekend plans.

I’d made it clear that I wanted to know everything I could about how my uterus and scarring looked during surgery. Dr. W let me know that everything internally looked great. There was no crazy scarring, no adhesions, no thinning or anything of note, and the vertical portion of my scar was “very small.” To quote him, it was “almost like a primary c-section.”

I did my best to stay calm in that moment, but I was so angry.

It would only get worse when I was wheeled into recovery where my husband and a nurse were standing over my baby, and I immediately noticed his chest was retracting. We tried to do skin to skin, but he was unable to clear his lungs and was taken away very quickly to the NICU. In a whirlwind I was told that he would probably be there for a few days, and I was given a rigorous pumping schedule.

Anger over being bullied into an unnecessary c-section turned into fury and grief when the very concern I’d tried to mention throughout my entire pregnancy became a reality.

This had been preventable.

I couldn’t talk and had to ask everyone to leave to give me some time alone until
I could finally stop shaking.

I wasn’t able to see my son again until later that evening, and he was pitiful. They had him on CPAP, gave him surfactant, and were monitoring him closely. We couldn’t hold him or move him and just tried to keep him quiet and calm to let his body adjust.

His official diagnosis was RDS which is directly related to his lungs not being ready. Because of the c-section, the fluid was not pushed from his lungs. Because he was too early for him, his lungs weren’t ready to handle it.

“Will we need to worry about pneumonia?” I asked.

“No,” he nurses replied. “He will be fine.”

He didn’t make any progress for the first day and a half and did, in fact, develop pneumonia. His X-rays were the first thing you saw on the back wall of the NICU when you walked in, and his lungs were white, full of fluid. He was put on antibiotics, intubated, given morphine to keep him quiet.

Our pastor come in later that day to give him an emergency baptism.

The first time I was able to hold him was on Day 3, and it didn’t last long. He self-extubated, arching his little body back and choking with panicked gasps. His hoarse cries were pitifully small. The respiratory therapist acted quickly and put him back on CPAP. Thankfully, they didn’t have to re-intubate him. He started slowly making improvements, and we just had to wait.

The hardest moment came when I was discharged and had to leave the hospital without him. That was when I really cried. It wasn’t right. It would have been prevented if care had truly been approached as a team.

The next few days, instead of bonding with my new baby and family at home, we had to go back and forth to see him and try to keep things steady for the kids left at home waiting to meet their little brother. The only things I was able to do for him were to pump and pray while recovering from major -unnecessary- surgery myself.

When they were finally ready to wean him from his oxygen and let him nurse, I immediately moved in to his room in the NICU. I was fortunate to have been able to do this with my mother to care for our other kids, but it was hard to leave them. I lived out of the hospital for the next few days while they continued to monitor his progress until he was ready to come home. It wasn’t an easy situation— recovery in the room was not comfortable, there was no easy access to a bathroom and no access at all to a shower or self care. The nurses and were incredible, but it was just not an ideal situation.

This pregnancy was really rough— not physically, but emotionally. Talking about what I was going through was frustrating, because not everyone understood or they made untrue assumptions. In a world where “women’s health” focuses on interventions, I had to fight to try and be heard and supported in what I knew to be the healthiest choice for me and my baby— a natural delivery.

Not only was I not heard, I was not given the chance to speak. Instead, I heard myself discussed outside of exam rooms, and was met with what I “had” to do rather than the courtesy of evidence-based conversations or approaching care as a team. I was excluded from decision-making in my own health at routine visits. To add insult to injury, there were people who defended doctors who said discussing my concerns was “a waste of time,” simply because they were doctors, and doctors know best.

The case for shared decision-making here is so incredibly clear. While hospital patient rights and responsibilities policies and ACOG guidelines emphasize respect for patient autonomy and individualized care, you would be hard-pressed to find this approach implemented in women’s health. This failure and lack of support for the patient in deference to the physician’s personal wishes can lead to long term emotional trauma and dangerous physical consequences for mother and baby. While physicians are protected by signed, often under pressure, patient consent forms, it is women who are left to cope with the scars.