A roller coaster of emotions | A natural (unplanned) caesarean in Rotterdam
What is a gentle caesarean section?
“In the operation theatre the lights are dimmed, the temperature is raised a little and you can have music playing if you wish. The sheet separating the parents from the surgical site is transparent, so that you can see your baby being born. This helps with bonding. The speed with which the baby is taken out of the belly is slower than usual, in order to allow optimal opening of the lungs. You are also allowed to touch your baby at this time. The umbilical cord is allowed to finish pulsing before it is clamped and cut. The pediatrician does their checks of the baby as quickly as possible and baby is then returned to you, unwashed and allowed to stay with you.”
More information can be found here:
This birth story concerns a caesarean section which was unplanned and did not go completely according to the description above, but the hospital did try to respect as many of the parents’ wishes as possible. The parents want to remain anonymous, therefore, there are no pictures where they are recognizable.
“Wow, I’m really touched by your birth photography portfolio. What beautiful photos; there is so much emotion in all of them. I would love to have this for my own birth. I’m now 29 weeks and due on 22 June.” This was the enthusiastic email I received from Paulien in April and we made an appointment for an introductory conversation.
A couple of weeks after that I meet Paulien and Patrick. They are both very enthusiastic about the photos and know immediately that this is what they want at the birth of their own child. They are having a girl and she will be born close to their home, in the Erasmus Hospital in Rotterdam. I regularly take photos in Rotterdam, but this will be the first time I’ve been into Erasmus Hospital. Because they live so close to the hospital, we arrange that I will park my car at their home and that Patrick will come and meet me there and give me a parking card. That saves on parking costs.
In May, Paulien sends me her birth plan. Paulien is a scientist and psychologist and she likes facts and having things well organized. She has drawn up a clear birth plan, which takes all kinds of possible scenarios into account. There is even a part in it about the photos that will be taken. In addition to Patrick and myself her friend Rachelle will also be present at the birth, for support.
Until 36 weeks everything is going well, apart from the standard pregnancy complaints, but then I suddenly receive an email at 36 weeks and 3 days. Pixel (the baby’s nickname) has suddenly turned into a breech position! An appointment is immediately made to try and turn her, but it doesn’t succeed since she’s already descended into the cervix, bottom first. Paulien has to make a choice: a vaginal breech birth, or a caesarian section. A caesarian is the last thing she wants, so she chooses a vaginal breech birth. Exciting!
But Pixel has other ideas and at 37 weeks and 3 days she decides to turn back into a head-down position! I didn’t see that one coming – usually babies don’t have that much room at that stage of pregnancy and considering her bottom had already ‘dropped’ into the cervix the chance that she would turn seemed very slim. But this just shows you again: nothing is as unpredictable as having a baby! It would be a ‘normal’ birth after all and both Patrick and Paulien couldn’t wait!
After the first World Cup football match in which the Netherlands play Spain (and beat them 5 – 1), Paulien is having Braxton-Hicks contractions every 5 minutes. For a little while she thinks labour may have begun, but perhaps it was just the excitement. 🙂 I ask Paulien if she could please avoid having the baby on the 23rd of June, because this is the day on which my boyfriend Denny and I have an appointment at 10am to register our civil partnership. Usually it helps when I mention things like this and some subconscious energy prevents the baby being born at this time. Hopefully it will work this time too! Paulien writes to say that she will do her best! 😉 Because of the Braxton-Hicks I am starting to think that baby might come a little earlier than due and not go overdue (first babies don’t come earlier as often as second babies do), but of course, you never know….
On June 16th we email each other again. Paulien has had regular Braxton-Hicks, but they’ve faded away again and for the first time in a long time she’s slept well: 12 hours! Now she’ll be well-rested for the birth! 🙂 We send a few emails back and forth and then it goes quiet for a few days…. until Sunday evening 22 June – it’s Patrick! Paulien is having contractions and they think that labour has begun. They’ll head to the hospital shortly and then he’ll contact me again. I look at the clock. It’s 21:00. In theory it’s possible that they’ll have their baby in their arms before tomorrow morning, 10am and that I can go ahead to the civil partnership ceremony, but I doubt it. I tell Denny that I don’t think I’ll make it, but that we’ll see how it goes.
At 21:53 Patrick sends me a message saying that Paulien is hooked up to the monitor. The doctor will come by soon to check if there is any dilation yet and whether labour has indeed begun. If not, they’ll be sent home and asked to come back the next morning. I am wondering whether I should go to bed. Patrick sends another message just before 23:00 to say that the doctor still hasn’t arrived and that I may as well get some sleep. When I’m in bed, I distantly hear a message arrive on my phone and look at it sleepily. No dilation, but the cervix is effaced and now it’s a question of waiting to see whether labour will really kick in.
I wake up to a phone call at 01:30. It’s Patrick and he tells me Paulien is dilated to 3cm. I’m on my way! I ask Patrick what we’ll do about the parking, but I can hear it in his voice: he’s nervous and finds it all very nerve-wracking and the cost of the parking makes no difference to him right now. He wants to stay with Paulien. It’s funny how some things seem so important beforehand, but then when it comes down to it, they are of no importance whatsoever!
At 03:30 I’m standing in the enormous, empty entrance hall of the Sophie Children’s Hospital. This is where the maternity ward of the Erasmus Hospital is, but I don’t see any sign telling me where to go and no doorman or anyone else who can help me. Nothing. I phone Patrick and he comes to fetch me. I walk into the room a short while later. There is one small light on and Rachelle is sitting next to the bed holding Paulien’s hand. The room is peaceful and Paulien is lying on her side, breathing through the contractions. I arrange another chair and sit in a corner of the room. I understand from Patrick that they checked Paulien again at 03:00 and Paulien was still at 3cm. They broke her water and there was meconium in the water. Pixel is doing well otherwise according to the monitor, so there is no cause for alarm. The contractions have increased in strength since her water was broken. When I look into the room I see that Paulien has got plenty of support from Rachelle and Patrick and I can concentrate on taking photos.
Patrick and Rachelle are taking it in turns to support Paulien. Patrick says sweetly to Paulien, “You don’t have to pay attention to me. I’m paying attention to you.” He looks worried and I feel for him. If it was up to him, the baby would arrive NOW so that it would all be over! At 04:30 Paulien turns onto her other side and vomits. At that moment the doctor comes in to check her progress again. She’s still at 3cm and that’s disappointing. The doctor proposes putting in an IV to induce stronger contractions. Pain relief is immediately mentioned and Paulien wants an epidural. In her birth plan she wrote that she would rather have no pain relief and be able to move around, but that if she has to choose she’ll take the epidural. I suggest that she comes out of the bed and maybe try to ease the contractions under the shower, but she wants to keep lying down because she says that feels best. The epidural is arranged and an IV is inserted. The medication to induce stronger contractions won’t be started until the epidural is in place, but there’s a long wait for the anesthetist and at 05:20 I hear Paulien say, “Where is the fucking doctor?!”, which makes it clear how she is feeling. 🙂 Soon after that they come in with some ‘bad’ news. The anesthetist has been called into an emergency caesarean and will not be available for the next hour and a half. The only possibility at this time is an injection which will take the edge off the pain, but also causes some drowsiness. Paulien immediately says that this is what she wants. When the nurse has left the room, I start to play the Devil’s Advocate. Paulien is doing really well coping with her contractions and she did a lot of thinking in advance about her birth plan and she didn’t want any other kind of pain relief. I remind her of this and that one and a half hours seems long, but really passes more quickly than she thinks, that the injection will mainly just make her drowsy and that after that she’ll still have to have the epidural put in. Is this really what she wants? If it is, then she should definitely have the injection, but it’s a good idea to think about it for a little longer, because once it’s done it can’t be undone. I can see her thinking about it and when the nurse returns she says, “I don’t want the injection.” We all tell Paulien she can change her mind at any time, but it seems like she is happy with her decision now.
In the time that follows Paulien copes well with her contractions, although she finds it very difficult. Patrick and Rachelle support her and Patrick just keeps telling her how proud he is of her. For Paulien it seems to take forever and just when she’s really had enough and is ready to say, “give me that injection now,” the message comes in that the anesthetist is available!
Just before the epidural is put in they check dilation one more time. It’s 06:45 and Paulien is dilated to 4cm. One more centimeter than last time, better than nothing, but it’s not going very quickly. At 07:00 the epidural is placed and shortly afterwards Paulien is looking much happier. The medication to induce stronger contractions is added to the IV, but the epidural is working and Paulien doesn’t feel any pain. The monitor shows that there are now strong, regular contractions. In the meantime, I’m starting to wonder whether I could drive back and forth to Middelburg for the civil partnership ceremony. I try to estimate how big the chance would be that I could manage to do this without missing anything and I think I have a good chance of making it, but you never know. I consult the midwife and she also thinks it’s possible, but also says, “Nothing is as unpredictable as birth.” I wait a little longer, but at 08:15 the nurse comes in and says it would be good if Rachelle and I leave for a little while and give Patrick and Paulien some time to rest. At that moment I make my decision: I’m going to try driving back and forth to Middelburg. I check whether Patrick and Paulien object and arrange with them that they will contact me immediately if the next check shows that dilation has suddenly progressed very quickly. If that happens I’ll turn around and head back immediately.
At 08:30 I fly out of the hospital, rush to Middelburg, sign the necessary documents and rush back. At 11:30 I’m back in the hospital and they’re just checking Paulien’s progress. When I step into the room 15 minutes later I hear that she’s dilated to 7cm. That’s so great – it’s starting to really happen! A scan is also done, because baby doesn’t seem to be lying in the ideal position. Patrick and Paulien have both gotten some sleep and now it’s time to have something to eat. Paulien keeps breaking wind because of the pressure and they’re joking about it. I hear her say, “I’ve never broken wind this much,” and Patrick replies, “You’re even beating me!” This is something you can’t stop and it’s a good sign that the pressure is moving downwards.
In the time that follows we chat about this and that and at 13:00 I see that the monitor is no longer registering the heartbeat clearly and eventually stops completely. The wires have come loose. Shortly afterwards they come and replace the wires and they check dilation while they’re there. Still at 7cm… This is not good news, because with such strong contractions we should definitely be seeing more progress. The midwife says she is going to consult with the doctor, because if it continues like this, they will have to do a caesarian section. When she leaves, Patrick and Paulien say that they will do anything to prevent this. I advise them to tell the doctor this and to ask what the possibilities are. The doctor comes in at 13:45 and concludes that baby is lying in a very unfortunate position. The doctor explains that baby is either too big for the pelvis, or the pelvis is too small for the baby and that a caesarian section will probably be required. This news is difficult for Paulien. She asks if she can do anything, but the doctor says the position of the baby is difficult to correct, but if she wants to try something, she can try getting into a hands-and-knees position to see if this changes the situation. If not, it will be a caesarian section.
Paulien is helped to turn over and lie with her bottom in the air. She is very upset and is crying. I feel for her. She is willing to do anything to avoid going to surgery, but this is out of her control. I decide to leave them alone for a little while.
In the meantime I try to find out what the chance is that I’ll be allowed into theatre with them. I know that Paulien and Patrick would really want that and that maybe this will help soothe them later if they have beautiful photos of this moment. The midwife is very kind and will do her best. When I return to the room I assure Paulien that I will capture as much as I can for her and that she mustn’t worry about it. I encourage her, but she is very sad and I can understand this. At 14:30 they come back to check on her, but nothing has changed. The decision is made: it will be a caesarian section. When the decision is made, things move quickly. Patrick just goes with the flow and mainly finds it upsetting for Paulien. In a way he is relieved that there is now an end in sight and that he will soon have his daughter in his arms, but he is also worried. Paulien gets changed and moves into another bed and I am told I can accompany them into theatre. Great! I will stay with Patrick, which is also good for him, since he won’t be alone for those last nerve-wracking minutes. We take Paulien up to theatre. This is a children’s hospital, so everything around us is very cheerful. Lovely colors, children’s pictures and butterflies on the cupboards. Paulien has 2 butterflies tattooed on her shoulders, which have a special meaning for her and it makes it extra special seeing the butterflies here now. Paulien and Patrick say goodbye to each other. We will go into theatre when Paulien is completely ready. Patrick and I go and get changed and have to wait until we are fetched. For Patrick these are the longest minutes of his life, I think. It seems to take forever and I try to chat about all kinds of things to kill a bit of time. In the end we have to wait 20 minutes and then we can go in. It’s 16:15.
Patrick sits on a chair next to Paulien and when the baby’s head is out, they lower the curtain so that Patrick and Paulien can see their baby come into the world. A beautiful moment! 16:23. She is briefly checked by the pediatrician and Patrick goes with her. He looks as though he just doesn’t believe what is happening and when the doctor says, “You can touch her,” he gently strokes her hand with his finger. He says, “Her name is Nova.”
They quickly check her and when they weigh her we see that she’s not a very big baby. She weighs 3370g. Patrick can then take Nova straight back to Paulien. While Paulien is stitched up, Patrick and little Nova stay with her and Nova stares at her mama. So sweet!
When Paulien starts to feel unwell I can see that Patrick doesn’t know what to do. He wants to stay with her, but he is holding Nova. I offer to take her for a little while and he agrees. While he holds Paulien’s hand and says sweet things to her, I hold their beautiful daughter in my arms. As soon as I can see that Paulien is feeling better, I go and stand close to them. She’s still not feeling great and is having trouble keeping her eyes open. I tell her that’s not a problem and lie Nova close to her, so that she can feel her and doesn’t have to look. Patrick takes Nova again and I let them enjoy just being together, the three of them. It’s so amazing that this is possible!
At 17:00 Patrick needs to take Nova upstairs for some more checks, but they will try to have him back as quickly as possible. He puts Nova in the incubator and goes upstairs with her. It seems like he is slowly starting to realize that he is a father now. Nova is measured and her temperature is taken and then she’s allowed to be with Patrick again. Shortly afterwards we can go back downstairs and at 17:40 mother and daughter are reunited in the recovery room. Nova has been busy opening and closing her mouth for some time now and as soon as she’s back in Paulien’s arms she latches on! Paulien was very worried that breastfeeding would be a problem if a caesarean was necessary, but it’s not an issue. She’s doing brilliantly! Not just Nova, but also Paulien is doing well, so she can quickly return to the ward. There Nova is dressed and her diaper is changed twice, because she just keeps pooping! I take some photos of Nova and of the family together and with the Netherlands-Chile football match commentary playing in one ear on my headphones, I say my goodbyes. Patrick asks once what the score is, but even though the match seemed so important a couple of days ago, it really doesn’t matter to him now. The most important things are in this room: his sweet Nova and his brave Paulien!