It happened several years ago, and it happened so innocently. It was a simple question, really. But it sparked such an outpouring of emotion, of heart-felt pain, of tears and of bitterness. Almost as soon as it was asked, it became apparent that a collective nerve had been touched. This was something bigger than any one of us, than all of us put together. A voice, loud and strong, sang in those days following that query. At times, it shook, cracked, even. It wasn’t a pretty tune, but it needed to be heard.

What’s so bad about a cesarean, anyway?

That’s what she asked. There was nothing angry or disrespectful in her question. She really didn’t know. Didn’t understand.

The answers she got aren’t everyone’s answers. Others would respond differently, for sure. And, admittedly, some might respond as loudly and provocatively to the analogous question, What’s so bad about a vaginal birth, anyway? All of these questions need to be asked, and answered. And we need to listen. Indeed, all of these voices need to be heard; this, I believe.

But, today, listen to these women. Hear them. Understand them. And cry with them. You will, I assure you, be changed.

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Years ago, while visiting Yellowstone National Park, Tim and I were struck by how much timber simply lay all over the forest floors. Timber not only from the fires of 1988, but from trees toppled by years and years of storms. The forest floors looked like piles of pick-up-sticks, logs toppled and entwined and tangled together, decomposition nearly frozen forever by the deep cold winters and the dry, dry air. For fifty years or more, that timber will struggle to become dirt once again.

In contrast, it takes hardly five years for the ravages of a good storm to simply disappear from sight here in the humid, wet, hot temperatures of home. Great trees toppled by angry hurricanes, felled by fierce Nor’easters — they melt into the forest floors, crumbling into rich, fertile soil in mere moments, it seems.

I really hadn’t thought about it in the better part of five years.

Sure, I’d thought about the day — that awful, awful day, when everything went so wrong.

I’d thought about how I’d been greeted in the elevator, calmly carrying my pillow and bags, by a doctor presumptively declaring, “C-section this morning?” “Oh, no!” I’d said, correcting him firmly, “Induction.” In hindsight, I can imagine the smile of smug pity he must have suppressed.

I’d thought about the arched eyebrow from the nurse as she listed to my plans to “avoid an epidural as much as possible.”

I’d thought about the confused, doubtful, and surprised expression on my doctor’s face as she discovered I’d in fact dilated completely, chagrined by her failed predictions.

And I’d thought about — oh, how I’d thought about! — the hateful, irritated tone in her voice as she declared she didn’t “have time” for my nonsense — for my screaming and pleading and crying because I could still feel, and that knife was so, so close.

I’d thought about all of that.

But one little detail had slipped past me. One little detail, lost, but for a chance.

Room 237.

I was following Mom and Dad into the Labor and Delivery ward. I had their bags; I was helping them get settled in. All of a sudden, Mom and Dad parted, leaving me a clear view of where we were headed. The door partially open, the great bed looming there, backlit by the window beyond. It all came back. It all came back.

Room 237.

A deep breath, and I stepped inside. This was not that day. This was a different day. A different Mom. A different Dad. A different me.

It’s hard to say how I felt about being back there, back in that room.  Yes, every once in a while, I’d remember my own moments in that room so long ago.  But, almost instantly — as quickly as it had all come back — it all went away. I forgot about that room’s history. I was there for Mom and Dad, not me.

So much had taken place in that room in the years since, and so much would continue to take place in the years to come.  It seemed as though my story was insignificant, lost the next day, really, as yet another mother walked anxiously into that room.  It was no longer that room.  It was only a room.

I thought of the trees.   I was sadened to think that nothing of my story remained.  There was no great tree, toppled in the wood, a frozen monument to my own story.  Mine had disappeared into the forest floor, along with thousands of others.

Then, that sadness passed.  Those great trees, frozen in time?  They’re mere ghosts, refusing to go gracefully from one life into the next.  My story wasn’t insignificant.  My tree, sunken into the forest floor, is now rich, fertile ground — the very ground upon which I stand today.

Cesarean Awareness Month. Hmm. I know what a Cesarean is. I’m aware of what a Cesarean is. Guess I can go home now, right?

Wrong.

I’m not an alarmist. Really, I’m not. But as I do this doula gig more and more, I’m flabbergasted at the incomplete and down-right incorrect information I see provided to moms and dads by their care providers on a regular basis. To wit:

“Are there any implications on future pregnancies if I have this cesarean?”asks a mom. “No, none at all,” answers the Doctor, “None at all. A cesarean is as risky as a vaginal birth.”

Really? First, I must laugh only a bit cynically at the statement that a cesarean is as “risky” as a vaginal birth. Um. Saying a vaginal birth is “risky” is like saying eating, drinking, pooping and peeing are “risky” activities. Things can happen, sure.  Things do happen.  But, folks, that’s life, not risk.

Then, to the doctor’s assertion that there are no implications on future pregnancies with a primary cesarean? Flat. out. wrong.  All sorts of placental issues (previa, acreta, and percreta) are well known to increase in incidence in cesarean moms.  These are not minor issues.  They’re life-threatening, and certainly hold great implications on your future fertility.  There’s even burgeoning research to suggest that getting pregnant might be more difficult with a cesarean under your belt (literally).  Then there’s the minor issue that you’ll be pressured in to additional cesarean(s) for all subsequent pregnancies, despite the fact that the research more than clearly bears out a vaginal birth after cesarean is far more healthy for moms (and as healthy if not more so for babes) than a repeat cesarean.  So.  “No, none at all.”  Is that Informed?

Most times, when a mom chooses to have an epidural, the anesthesiologist comes in  and reels off the risks of “headache, paralysis and death — but only very, very rarely.”  The anesthesiologist is right.  But what about the increased risk for a cesarean? This isn’t broached — ever.  And that risk?  Is not at all rare.  Informed?

And then there’s the seduction of induction.  Mom is tired.  Mom is uncomfortable.  And mom is 40 weeks.  Mom hears that to not induce means risking a placental deterioration and a stillborn child, or, god forbid, a gargantuan baby that can’t fit.  Mom does not hear that the research shows these risks are real after 42 weeks.  Not 40.  Mom does not hear that even the trade-union to which her doctor most-likely belongs (ACOG) defines post-dates as going beyond 42 weeks.  Not 40.  And certainly Mom doesn’t hear that inducing her increases her risk of cesarean (if she’s a first time mom) by 100%.  DOUBLE. THE. RISK.  Mom doesn’t hear this. Informed?

I started off saying I’m not an alarmist.  I’ll say it again.  The issue is not whether you choose to have an epidural, or an induction, or even an elective cesarean.  That is your choice.  Truly, it is.  But, when you make these decisions, be informed.  This stuff — the misinformation, the incomplete information — that I witness, with almost every birth I attend in the hospital?  It’s not the exception, it’s the rule.  One day, we’ll break that rule.  Utterly shatter it.  But until then?

April is Cesarean Awareness Month.  Be Aware.  Be informed.

I step into the steamy shower and let the hot water run over me.  Forty hours’ worth of sweat, tears and more, all washed away; the emotional grime, scrubbed free and rinsed.  Clean.  Refreshed.  Refocused.

In the hospital, a new mother hobbles into the shower.  Hunched over, grimacing, her tears mingle with the water as they stream down her face.  No shower will ever wash away the memories, the pain, the hurt, the fear.  Her hopes spiral down, down.  Gone.

I feel so dirty.

If I have a religion, it includes in it a healthy trust and faith in Mother Nature. And Mother Nature is never more present than at the birth of a child. I don’t believe she’s right all the time — no one can be perfect — but I know she’s wise, and her vision extends far, far beyond mine. I don’t question her designs as much as I try to understand them; I don’t fear her plans as much as I try to trust them. But, I’m not perfect, and I know that my ignorance and confusion are, at their root, my shortcomings — not those of Mother Nature. Each birth I attend, then, is an examination, a test, if you will, of my faith. My desire — compulsion, really — to write about each birth is my way of exorcising the ignorance and confusion to make room for more understanding and trust.

Her water had broken the night before, and labor had not started. When I arrived at her bedside, as a volunteer, she was hooked to an IV, the hissing pump forcing pitocin — a manufactured form of Mother Nature’s labor hormone — through mom’s body. Her uterus was contracting in response to the drug, regularly and powerfully; her manufactured labor eerily mimicing that of Mother Nature’s quite well.

But hours and hours and hours later, mom was no closer to giving birth to her child than she had been the night before. No progress. No change. All those contractions, and, simply, no change. “Failure to progress”, the doctor said. Another primary cesarean, performed in a puddle of mom’s tears.

Failure to progress. The mystery that is Mother Nature weighed heavily on my heart. How can she appear not to work, yet again? The broken water and absent labor — that is something I understand. That is not a failure of Mother Nature as much as it is a failure of human nature: impatience is all too often our downfall. But I know Mother Nature is stronger than our shortcomings. Why, then, all of this apparent failure? Where is the triumph of her strength? Where is her victory? I stood in the hallway, watching mom disappear into the surgical suite, and I struggled to understand.

I don’t question her designs as much as I try to understand them; I don’t fear her plans as much as I try to trust them.

A few hours later, mom in recovery, dad with his son, and me standing by, trying desperately to make sense of it all, I listened as the nurses gleefully reported the past few hours’ activity. It had been a busy evening, and the bustling nursery was evidence to the fact. “A busy night,” the charge nurse said, “nine vaginal births and one cesarean inside of three hours.”

Her vision extends far, far beyond mine. Victory.

I’m not a big believer in destiny. I don’t believe our paths are pre-determined; I believe it’s the choices and decisions we make that become the paths upon which we trod. But even if the paths that we choose are entirely ours, the forks in the road, the twists and turns around corners, and the hills and valleys placed in our way are not entirely in our control. We can choose the path that appears less steep, only to find an unexpected mountain around the corner. It’s what we do with those mountains in our way that makes us who we are.

Mom had her plan. She’d made her decisions and she knew what she wanted. Her path was steep, but she knew where she was going. She was going to have a VBAC.

I’d had my doubts, to be honest. A little bit of drama, a few displays of histrionic melancholy, had made me question Mom’s mettle. Mom’s plan was going to take a lot of strength, and I wondered…

Shame on me. Mom had strength and then some.

As the day wore on, she fixed her deep brown eyes in mindful concentration with each contraction. Her body rocked quietly; her thoughts focused inward. Contraction by contraction and step by step, Mom walked her path. Mom followed her plan.

But then her plan started to unravel. All the preparation and effort failed her as her path twisted and torqued violently. Suddenly, Mom was faced with unexpected choices and unwelcome decisions. All of them, too much a reminder of her previous experience. But, this time, what had previously been cruelly and unkindly taken away from her — her ability to make choices — lay solidly in her hands. Now those hands ached and trembled with uncertainty and confusion. Her steep path suddenly became unmarked and obscured.

She could have crumpled. She could have relinquished her choices, absolving herself of responsiblity. It certainly would have been easier.

Instead, she relinquished her pain. She let go of the hurt and fear and confusion and absolved herself of blame. She faced the unexpected choices anew, refusing to believe the past was a glimpse of the inevitable in front of her. This was not the same birth. She was not the same Mom. She made a choice, a new plan, one that looked frighteningly like the plan thrust upon her years ago. And this — this — showed her mettle and grace, more than anything else. Mom took a deep breath, and stepped on. Her choice: to trust, to hope, and to believe in herself.

Hours later, her path came to a restful pause. She’d let go. And then, she reached down and held on — to her new daughter coming in to the world.

That restful pause? Was at the top. It’s what we do with the mountains in our way that makes us who we are.

Hot off the press. Hell, it isn’t even off the press and onto the CDC’s website yet, but…

2005 Cesarean Rate: 30.2%

The rate is up 4% from the previous year, which was up 5% from the year prior to that.

And we’re still among the bottom among industrialized nations in maternal and infant mortality and morbidity.

Hmmm.

(Updated:  The official source of data, the CDC’s 2005 Preliminary Birth Data, is available here.)

(Warning: Very Bitter Post Ahead)

Strictly speaking, there wasn’t any medical need to induce her labor. Baby was fine. Mom was fine. But baby, simply, wasn’t here yet.

Did anyone stop to think, “Really, we’re in no hurry. There’s a reason why baby is not here yet. Let’s not presume we know more than the baby at this point.”?

No. The Emperor knew better. The Emporer knew it was time.

And when they went to place a bulb on her cervix, to “encourage it to move along”, and it simply wouldn’t go in, because her cervix was high, tight, and posterior, did anyone stop to think, “Maybe there’s a reason why this bulb won’t go in. Maybe she’s not ready to have this baby. Maybe the baby’s not ready to come.”?

No. The Emperor knew better. The Emperor knew it was time.

And when they went instead to give her a drug to soften her cervix, did anyone stop to think, “Maybe the off-label usage of this drug for induction comes with warnings for a purpose. Maybe, even though it’s the cheaper choice, it’s not the best choice. Maybe there’s a reason we shouldn’t use this drug.”

No. The Emperor knew better. The Emperor knew it was time.

And when only a few short hours later, all sorts of bad things happened, did anyone stop to think, “Maybe, just maybe, all this fiddling around might have caused this mess we’re in”?

No. The Emperor knew better. The Emperor knew it was time.

And when mom asked for just a moment to cry alone, to face her fears, to steel her nerves, to get ready to be cut, did anyone stop to think, “Maybe, just maybe, we shouldn’t have tried to fix what wasn’t broken in the first place.”?

No. The Emperor knew better. The Emperor knew it was time.

Everyone around is singing the Emperor’s praises. Mom is healthy. Baby is healthy. Were it not for that quick cut…everyone shudders to think what would have happened without the Emperor.

I shudder to think, too. The Emperor has no clothes.

I’ve always been captivated by tattoos. Mom and apple pie, a sweetheart, or a favorite animal — these things don’t capture me. I’m captivated by the idea of marking your body — on the outside — to reflect something on the inside. But, I’ve never felt a personal need to do so.Until recently.I’ve been doing a lot of work, chez Kristy, of late. There’s more to come on that front, and so much more to say, but, at its simplest, there’s been a little remodeling going on. Tearing down some walls, opening up some windows, letting the light shine in — that kind of work. Lots of sweat and still more tears. But the result? Coming along nicely, I must admit. Coming along nicely.

It dawned on me over the last few months that a tattoo makes sense for me now. I wanted — needed — to mark my body in a way that reflected what I’ve been doing, what I am doing, what I will have done. I wanted to take back a part of my body that had been taken from me. I wanted to celebrate. I wanted to smile. And so, a dogwood, for spring, natural beauty, and so much more, and characters meaning to heal, have been placed upon my body.

Ink. Permanent. Indelible. Mine.

It’s been the elephant in the living room ever since I began practice as a doula. How much will my experience shape the way I react to the experiences of the people I am supporting? Is it possible that my experiences could hinder my ability to support someone experiencing the same? I’ve been wisely cautioned that I can’t be out to “save” someone. I can’t be out to give her the experience that I would want. I have to understand: it’s not about me, it’s about her. So, can I keep my experiences out of hers?

Kristy, meet the elephant.

Yesterday evening, after a long and bravely-fought battle, my client went under the knife. And I was there with her in the operating room.

The fear in her eyes, the confusion and uncertainty in her voice, the disappointment in her sunken shoulders — all so much like me five just short years ago. And when she cried out in pain and they told her it was only “pressure”? The similarities were just too striking. The elephant was charging.

But I held strong. I understood my purpose. Yes, the memories were there with me, in that very room, but instead of igniting fear and terror, they served to bring forth empathy and genuine concern. I wanted, more than anything else in the world at that moment, to make a difference for her. I held her hand. I told her I understood. I let her know — I knew. And we cried, together. My tears were for her.

Oh, I was mad. Mad at the circumstances that stacked a deck against her. Mad at the choices she was given. Mad at the choices she was denied. Mad. Mad. Mad. And, for her, I am only sad. No, none of this is her “fault,” yet she will be the one to reap the consequences. That is what is so very sad — for me.

And yet? I am happy. Happy to make that difference. Warmed to be there when her partner and mother could not. Privileged to hold her hand. Comforted to listen to her, hear what she was saying, and validate her. And, yes, relieved to have found a way to help her make her own decisions, with confidence, though perhaps not without discomfort. Out of my experience came an empathy from which I could draw on to comfort and reassure her — during her own experience. The challenge — to draw on, but not dwell on, my experience — is deep, but the reward is far deeper.

So, I’ve met the elephant. And he’s not as wild and unruly as he’s rumored to be. I’ve no doubt, in fact, that elephants do indeed cry.