Pushing During the Pandemic
The uncertainty and chaos of giving birth during a pandemic is almost surreal. Under the most ideal circumstances, pregnancy and childbirth can be a scary and uncertain experience. But during the beginning of New Jersey’s lockdown mid-March — a mere two weeks before I was due with our second son — state and hospital policy was literally changing by the hour.
For this birth, I planned to have a VBAC (vaginal birth after cesarean). I would not say I had strong pro-vaginal/natural birth leanings. But I was firmly in the anti-cesarean camp after my first C-section delivery, which was accompanied by a brutal recovery. So, for my second pregnancy, I chose a midwifery practice that had a high success rate with VBACs as well as an affiliation with an excellent hospital and NICU.
I planned to go on maternity leave at 38 weeks from my job as an in-home mental health clinician. My last week at work was filled with frantically changing policies that resulted in me working from home by mid-week and pulling our toddler from his daycare. My husband works in education and began working from home that week as well. At that point, I was blissfully unaware of the severity of the pandemic and what the new restrictions would mean for me, my family, and my birth experience.
The first Saturday of my maternity leave, one of my midwives called to inform me that the hospital changed their policies regarding VBACs.
The hospital was no longer permitting attempted VBACs.
I would have to schedule a C-section.
I felt devastated as I learned this news.
While I understood labor rarely went according to plan, I struggled to wrap my head around the idea that I would not even be allowed to try to avoid a major abdominal surgery. I also struggled to understand how a major surgery could be lower risk than a vaginal birth.
I cycled through a huge range of emotions that day; the most disorienting was the feeling of complete loss of control. My choices regarding my health and my family were being taken away.
After carefully questioning my providers as well as friends within the field, we confirmed that I could not be forced to have a non-emergent surgery without my consent. Furthermore, many of our acquaintances in the medical field indicated that they could not understand the hospital’s reasoning behind their anti-VBAC edict. So we settled on our plan- I would schedule a C-section for 39–40 weeks and hope I went into labor prior to the scheduled surgery. I would then refuse an emergent C-section when I presented in labor.
The stress and anxiety of that Saturday is possibly what caused my water to break late that evening. I called my midwife to share my status as well as my intent to refuse a C-section. She asked me several times if I was sure. We were. My husband and I had thoroughly discussed our options. While we understood the hospital was implementing what they thought was the best policy for patient health and liability, we needed to be advocates for my health and the health of our child.
Despite our confidence, my anxiety was through the roof. I wasn’t certain I was making the right decision, but my gut told me I was.
After admission, multiple providers reviewed my decision and explained they had to make sure it was properly documented. Providers reminded me on multiple occasions that if I had a prolonged labor and needed an emergency C-section, it might be complicated. They also warned me that if I spiked a fever, they would treat me as a presumed positive COVID-19 case and separate me from my baby at delivery.
We apologized to our providers profusely for making their jobs more complicated with our decision. But we held firm. Everyone was supportive and professional despite our decision to push back against hospital policy. And approximately 7 hours after my water broke, our son was born — vaginally — just in time for the shift change. I felt like every nurse on duty was in my room to see the “lady that broke the rules” give birth.
I was discharged less than 36 hours after admission. Within our brief stay, the hospital changed policies twice more — first to eliminate all support people (my husband was told, without notice, to leave immediately a few hours after my son’s birth) only to see that policy changed again several hours after that (my husband was allowed to come back). We were fortunate that my husband could be with me for labor and delivery. I cannot imagine how awful and isolating the experience would have been just 12 hours later if I had to deliver alone.
If I had not understood my right to refuse procedures and held firm on my decision, my birth experience may have been very different. What a lonely and terrifying experience it might be for women who may not have knowledge of the healthcare system. Certainly, providers didn’t lay out my options clearly, apart from rigorous prompting on my part. I heard from nursing staff during my stay that at least one other woman who had been informed of the policy change regarding VBACs opted to wait until she was extremely close to delivery to come to the hospital in order to avoid a C-section. She ended up giving birth in the parking lot. A VBAC in a parking lot is surely a high risk situation and potential strain of medical resources — the very thing the hospital was trying to avoid in their policy.
As a mental health clinician, I am concerned about the trauma experienced by women who may have been pressured into a medical procedure that they neither wanted nor understood. Postpartum PTSD(post-traumatic stress disorder) — like postpartum anxiety and depression — is not a widely discussed topic. But many women are impacted by this devastating condition, and I suspect that will only increase due to the pressures and stresses of giving birth during a pandemic. Pre-pandemic professional estimates vary wildly that anywhere from 1–25% of women experience birth trauma that leads to either full blown PTSD or results in one or more PTSD symptoms (e.g., flashbacks, anxiety, hyperarousal, depression, etc.).
I am incredibly grateful and fortunate to have navigated my birth experience without lasting negative mental or emotional impacts. I have no doubt that had I been passive in my birth plan, I would have lost complete sense of control. Had I not pushed for my medical rights, pushed the medical system to listen to its client, and pushed myself to stand firm, I would not have had the opportunity to push during the pandemic.
