“You’re just going to schedule another C-section, right?”
I can’t count the number of times family and friends asked me this during my second pregnancy. Before I even had a chance to really consider what would be best for me, my baby and my family, the people in my circle made the assumption that my next birth should be exactly like my last birth.
And I know I’m not the only one who experienced these kinds of remarks.
Unfortunately, so many of us are led to believe certain things about our bodies, our abilities and our options for birth. And many of those things simply aren’t true.
Much of what we do here at The VBAC Link is to help inform, educate and build community around the idea that birth after Cesarean can be better. We believe that every mom deserves the opportunity to build a birth experience that feels right to her, regardless of what that looks like.
Our team is so, so excited to dig into today’s topic – maternal assisted Cesarean (MAC) – because the entire idea (one that’s becoming a very real possibility for women around the world) proves that birth after Cesarean can be customized, can be within your control and can be better.
We hope you’ve seen the content we’ve been able to share about Paige, a team member here at The VBAC Link. You will be in awe watching her MAC video and completely inspired hearing her full birth story on the podcast. And, as a special treat, Paige agreed to do a full interview for our blog to help us really understand what MAC looks like and how to plan one for yourself.
What does an MAC look like?
Before we really dig into the details, you might be wondering… what’s the difference between an MAC and any other C-section? Well, to put it simply, a maternal assisted Cesarean gives the mother the opportunity to be actively involved in delivering her baby.
Paige, how did your MAC look different than your previous Cesareans?
There were SO many differences! Each of my three previous Cesareans were a little different, but through them all, I have experienced not knowing the providers performing the surgery until the day of, hospital bands, arms strapped down, general anesthesia, extreme drowsiness, shakiness, nausea, no photographer or doula, and skin reactions to steri strips. I was never given skin-to-skin or the opportunity to breastfeed in the OR. Each time I saw my baby, they were already swaddled and wearing a hat. Due to various circumstances, I was not able to hold any of them within the first hour of birth.
My MAC provider, Dr. Peter Chung at Houm Obstetrics in Seoul, South Korea, was very progressive and the location was unique. It is essentially a birth center with an OR on site. I did not have hospital bands. My water broke and labor began unexpectedly, so we called in the team to move up the surgery. During the four hours that I was laboring there and waiting for the team to arrive, I did not have an IV or continuous monitoring.
My doctor, midwife, doula, birth photographer, and husband were all in attendance. Dr. Chung washed my hands with the sterile solution and I wore gloves to maintain sterility. After my spinal was placed, my gown was replaced with a sterile one. The heart monitor was on my toe instead of my finger. The surgical drape went up, and my gloves were then removed. My doctor endearingly joked that I was the director and a fellow surgeon. I had music of my choice playing in the background. My arms were free. The OR was warm, and the lights were more dim than usual. The environment was reverent and respectful.
As soon as the head was born, the drape was lowered. I reached down and pulled the rest of his body out of my abdomen immediately onto my chest. It was the moment I had so desperately been craving, and it was just as beautiful as I hoped it would be.
The drape went back up during closure. I breastfed in the OR. The cord stayed attached to the placenta for almost two hours after birth, and my husband was able to cut the cord for the first time. Newborn exams were delayed.
How did this difference impact your immediate postpartum experience and bonding with your babe?
Thankfully, I have always felt very close to my babies right away, but my ability to care for them immediately has been very different.
My immediate postpartum experience was especially rough with my third. I had fought so hard for a VBA2C and was devastated that I didn’t get it. I cried many sad and frustrated tears. During my first postpartum shower, I was crying from being in so much pain and from feeling so defeated that my husband had to help me through most of it. I did not have the strength to change any of my son’s diapers, and he had to bring him to me to breastfeed each time.
Right after my MAC, I still felt pain, of course. C-sections are major surgeries no matter how they happen! I still had significant hormonal changes and many emotional releases. Yet this time, my tears came from intense gratitude and love. The thought of leaving the birth center sent me sobbing because I felt so cared for. Very quickly, I was able to walk, change diapers, and independently feed my baby. While I was showering myself there for the first time postpartum, my husband cracked a joke and I laughed so hard, I peed! Sure, a little unhinged, but a silly memory.
I had been familiar with how a difficult birth experience can impact you postpartum, but I really was not prepared for just how much a great birth experience can impact you for the better.
Planning Your MAC
As you might imagine, MAC isn’t widely practiced (yet!). Paige had a beautiful experience with her provider in South Korea, and we are starting to see more and more MACs happening around the globe, but it’s not as simple as checking a box on your Cesarean Birth Plan.
How did you decide MAC was the choice for you?
While preparing for my VBAC attempts, I was so energized. I loved taking care of my body. I loved all of the learning, and I loved advocating for myself and my baby. My intuition confirmed to me so many times that I was going to achieve this dream. So when I didn’t, I was a little lost and didn’t know what to do with all of the information I had worked so hard to learn. I truly thought my purpose would be to advocate for VBAC by getting one myself.
While transcribing The VBAC Link Podcast Episode 220 about MAC with Dr. Natalie Elphinstone, I felt the same fire that I had while I was preparing for my other births. At that point, it had been years since my last birth. The seed was deeply planted in me to start looking into it as an option.
I began finding out everything on MAC that I could on social media, podcasts, blogs, and articles to make an educated choice. My provider was actually supportive of a VBA3C if I wanted that. It was a hard decision because I will always love VBAC and be a strong advocate for it. But ultimately, through prayer and listening to my intuition, I knew that the fire in my heart was leading me toward advocating for MAC to become an option for women in South Korea by being the first one to do it.
Walk us through the steps you took to plan your MAC.
I presented this video to my doctor at about 20 weeks. It was the only one I could find that showed the entire process.
He watched it with me and asked if this was the type of birth I wanted. I responded, “Yes. I think it would be really special.” To my surprise, he said that he would be happy to help me have this new experience and thanked me for the opportunity to help him grow as a doctor.
Dr. Natalie Elphinstone emailed me her hospital policy and procedures for a MAC which I forwarded to my doctor. My doula prepared a MAC presentation to the entire birth center staff. We scheduled a surgery rehearsal at 35 weeks where we walked through each step as it would happen the day of.
We also had a plan in place in case I went into labor before my scheduled date. Dr. Chung said that it would be no problem as it would actually be better for the baby if I labored a bit! He only needed one hour to call in the team. I’m glad we had that plan in place because that is what ended up happening.
What was the most difficult part of planning your MAC?
Asking. I was terrified to ask. I was worried my doctor would think I was criticizing his current practices or telling him how to do his profession. I was worried about being a “problem patient”, rejected, or patronized. We can’t control how our providers react to things we ask for, and that’s a tough reality. My provider could have responded very differently, but thankfully, he was very receptive.
What advice would you give to parents considering a MAC?
I’d actually like to share the advice given to me from my friend, Nicole. I found her incredible story on The Birth Hour Podcast Episode 875 while I was pregnant. She had the first maternal assisted Cesarean in Michigan. I reached out to her and expressed some of my hesitations, worries, and fears. She gave me so much encouragement and the biggest virtual hug.
“I had so many similar fears about chickening out or feeling afraid in the moment, and it just wasn’t the case. It felt so empowering to be the person catching my baby.
You will never feel more powerful than pulling a baby out of your own belly during awake surgery. It’s like some sort of superhuman experience that I can’t even describe. You just feel like a total badass. And frankly, you are!
With my first birth, I felt like every piece of what I had wanted or planned fell apart as my labor and postpartum unfolded. I felt like my body was broken and that giving birth was something meant for other people, but not for me. It was so redemptive to take back the power in my own birth.”
I don’t think I will ever NOT get chills reading her words! Thank you, Nicole. I couldn’t have said it better myself.
We are so, so grateful for Paige, her willingness to share her entire experience with our community and the rest of the world, and the light she shines on the possibility of a world where every mom gets autonomy over her birth experience, including Cesarean.
Finding More Information
We understand that planning your ideal birth isn’t always easy, and choosing an MAC is no exception. There isn’t much evidence-based information widely available yet, but here is a list of resources from around the web that you might find helpful…
- Anesthesia for the maternal assisted caesarean section (cost $24.95 for full access)
- Maternal Assisted Caesarean by Dr. Stephen Cole
- Maternal Assisted C-Section Birth: Lyz’s Birth Story
- A special maternal assisted C-section birth at The Mother Baby Center
Lastly, if an MAC isn’t something you’re quite ready for, be sure to check out our information on Family-Centered Cesareans, an option that gives you more autonomy in making choices about your Cesarean like using a clear drape and playing your own music.
As always, my strong friend, here is an affirmation and reminder…
VBAC Nutrition for Fertility, Pregnancy and Postpartum Explained