C-section Stories

Rarely do women raise their hand to have a cesarean section. It is typically the result of a vaginal delivery that has gone on too long or a delivery complication that gets these women a fast pass to the operating room. In honor of C-section Awareness Month, four moms who are also Associates at the Center for Maternal and Fetal Care at The Children’s Hospital of San Antonio share their C-section stories and hope women who might be faced with the decision hear their experiences and feel more prepared.

They highlight the good and the bad to give other moms a true picture of what C-sections are like in a variety of situations from a planned C-section to ones that result due to an emergency. The common theme they want to communicate to their patients is to let them know that while having a C-section would have not been their first choice, they would do it all over again to know their baby was safe.

Maci Reyes, Medical Assistant, Center for Maternal and Fetal Care, The Children’s Hospital of San Antonio After having her son seven years prior, Maci knew she wanted to get pregnant again, but she and her husband were having trouble this second time around. They had tried for almost six months with a negative test each time, but it finally happened, and at a time when she was least expecting it.

“I was shocked, because before then we would take a test every month and it was always negative, remembers Maci. “I was nervous and really excited. I didn’t tell my husband right away. He was out of town and it was his birthday so when he got home, we surprised him with a onesie that said ‘Happy Birthday Daddy’ and that’s how we told him.”

With Maci’s first pregnancy, she suffered from hyperemesis, which is extreme, persistent nausea, and vomiting during pregnancy and Maci was in the hospital for most of her pregnancy.  This time around, she still suffered from the symptoms, but was much more prepared and able to work almost all the way up until delivery.

When delivery day arrived, the nurses broke Maci’s water at 7 a.m. She was looking forward to a vaginal birth like with her last delivery. At 8:30 p.m., after being in labor all day, her doctor gave her news she was not excited to hear. Because the baby was in distress and her heart rate was low, she would need a C-section.

“I never thought I would have a C-section and I was scared,” explained Maci. “My first delivery was so easy, so when the doctor said we were going to have to do emergency C-section; it was the scariest thing ever.”

Maci remembers how her husband helped her through the experience and how the doctor talked her through the whole procedure in the OR. He gave her the play by play, which helped to calm her nerves.

“This was not what I wanted, but once I heard her cry, I was calm,” said Maci. “I would do it all over again to ensure her safety.”

Maci sees patients all day long at the Center for Maternal and Fetal Care and said if she had advice for her patients, she would tell them, “It is normal to be scared, especially if you have never had one. But, if it is something that needs to be done for the health of your child, then you know it is the right thing. It is not as scary as it sounds because you know you are in good hands with your doctor.”

Maci added that although her C-section was painful, it was not a bad experience. The healing processes are different with both a virginal and C-section birth. “I felt like I could get up and do things much faster than with my vaginal delivery.”

Her daughter Malori was born on June 12 and is about to turn 3 years old.

Maci Reyes describes her C-section as “the scariest thing ever,” but would do it all over again to ensure her baby’s safe delivery.

Kimberly Gates, Sonographer, Center for Maternal and Fetal Care, The Children’s Hospital of San Antonio Kimberly found out she was pregnant when she was just five weeks along. It was a wonderful pregnancy journey with no complications.

“My pregnancy was amazing, no problems at all. I carried my son until 40 weeks,” explains Kimberly.

On delivery day, Kimberly’s labor had to be induced because her son was in a posterior position. Also known as a sunny-side-up baby, this is when the baby is positioned head down but facing mom’s abdomen, making labor and delivery much harder.

“My doctor determined it would be safer for both me and the baby if I had a C-section because my son would not turn,” remembers Kimberly.

Kimberly initially wanted a vaginal delivery but safety was her top priority and she was just happy to have her son, Ayden, arrive safely. The C-section went well but Kimberly remembers the recovery being very difficult due to her abdominal muscles having incisions.

“I didn’t realize how much you actually engage your abdominal muscles during the day. I would encourage moms with a C-section to give your body the rest and chance to recover from this major surgery,” said Kimberly.

Two years later, Kimberly had a scheduled C-section to deliver her daughter, Ansley at 38.5 weeks.

“I felt like the recovery with my second C-section was better,” remembers Kimberly. “My body recovered a lot faster with less pain.”

While having a C-section was not the path Kimberly wanted to go down, it doesn’t make her feel like less of a woman or mom especially now as she is raising her two teenagers, Ayden and Ansley who are 16 and 14 years old.

Kimberly adds, “That scar is well earned, and I never look at it in shame. I am a mother and the privilege and love that comes from that outweighs the procedure.”

Brenda Gonzales, Medical Assistant, Center for Maternal and Fetal Care at The Children’s Hospital of San Antonio Brenda got a big surprise when she went in to get her IUD taken out.

“I went in for my annual check-up and instead found out I was pregnant!” said Brenda.

While Brenda’s pregnancy was considered high-risk since they could not locate the IUD, her overall pregnancy was uneventful.

On delivery day, Brenda arrived bright and early at 6 a.m. to get prepped.

“I was so nervous, and the labor wasn’t progressing,” remembers Brenda. “My son, Jeremiah, had turned at the last minute and they saw he had his cord wrapped around his neck, so they sent me right away for a C-section.”

Brenda said her C-section went really well and was happy with how she was sewn up using stitches instead of staples.

Brenda’s biggest piece of advice for moms regarding C-section recovery is to take your medications when you get home. “The recovery wasn’t what I expected,” said Brenda. “If I didn’t take my meds they sent me home with I wouldn’t have known what to do because even sneezing hurt, but the meds helped a lot.”

Brenda’s son Jeremiah was delivered by emergency C-section due to complications.

Yvette Sancho, Office Manager, Center for Maternal and Fetal Care, The Children’s Hospital of San Antonio Yvette had two pregnancies and both children were delivered via C-section. Her first pregnancy was a complicated one. At her 20-week anatomy scan, she found out her baby had gastroschisis, a birth defect in which the baby’s intestines extend outside of the abdomen through a hole next to the belly button.

She was watched closely throughout her pregnancy but knew she and her baby had a tough road ahead as this was a condition that would require several surgeries and months of NICU time.

“Due to her condition, my OB determined it would be safest for her if I had a C-section,” remembers Yvette.  “It wasn’t something I wanted. I wanted to have the whole birth experience and really experience labor, so I was pretty disappointed.”

Yvette’s C-section was planned, but baby Alejandra had a different plan. “I actually started to go into labor,” explains Yvette. “It was 4 a.m. and I woke up and my water had broken, and I was like ‘oh boy, it’s time.’ So, we rushed off to the hospital and waited for the physician to come in to perform my C-section.”

Alejandra’s gastroschisis was one of the worst the doctor had seen. She had several surgeries and after three, the doctors determined there was not much more they could do for her and they transferred her to another hospital for palliative care. Sadly, she passed away four months later from internal bleeding.

Yvette’s first daughter Alejandra died at 4 months of age due to internal bleeding caused by a condition known as gastroschisis.

“She would have been 21 years old,” said Yvette. “The more and more I have talked about it over the years, it really helps me to tell her story.”

Looking back on her experience and her C-section, she said that even though it wasn’t what she wanted, and it was a longer and more painful recovery, she would do it all over again.

“Was the C-section something I wanted? No. Did it go well? Yes, it did. But, it was hard afterwards,” remembers Yvette. “It was like learning to walk again. I could not laugh, cry or cough without being in pain. The hardest part was having to get up and walk again. My baby was in the NICU, so I had to get to her which became my motivation to get up and walk!”

For many women, a C-section is their first surgery and Yvette reminds patients that it is normal to be scared of the unknown, but trusting in your physician is the key.

Yvette did get pregnant again many years later and had a second, scheduled C-section since she had a C-section for her first pregnancy.

“Lila was born on October 1, 2009. I was scheduled for her delivery and went in very early in the morning,” remembers Yvette. “I was ready. I had done this before, and I felt prepared.”

Yvette remembers being nervous as she was wheeled into the operating room, but Lila was out within a couple of minutes and all of that fear disappeared.

“She was beautiful and had so much hair,” explains Yvette. “Having had a C-section before, I was prepared for the procedure and the recovery process and it was a lot easier this time around.”

Yvette’s daughter Lila arrived via C-section in October 2009.

For women who are scared to have a C-section, Yvette would tell them, “If it is going to be in the best interest of you and your baby, it is worth it. We have come such a long way in medicine. My daughter was in and out in several minutes. Before you even have a chance to be afraid of it, it’s over.”

If you want to learn more about C-sections, you can view a video that explains the procedure here. If you would like to talk to an OB about your pregnancy, our team of OB/GYNs and MFMs would be happy to consult with you.

Holding on to Hope: A High-Risk Pregnancy Journey

In June of 2020, Lauren found out she was pregnant again. What would have seemed like a joyous occasion brought a lot of fear to Lauren since just a few months earlier she had lost a baby at 11 weeks. This time she was hopeful, but told herself she was not going to get attached. Just in case. This pregnancy would take Lauren on lots of twists and turns and several ups and downs, but in the end, she would learn a lot about her own health, how strong she is and how choosing the right doctor can make all the difference.

During Lauren’s first trimester, she was very careful not to let the news about her pregnancy slip to anyone except her mom and her husband. Lauren put her focus on Andi and Cody, her two other children, ages 4 and 2 ½ who were keeping her busy these days.

At 11 weeks, the same week she lost her previous baby, Lauren was attending her first regular appointment with her obstetrician when her doctor noticed some things going on with her health and had some lab work drawn. This lab work brought more answers than Lauren would have ever expected. It was at this time when Lauren learned her thyroid was not functioning properly due to Graves’ disease. This is what likely caused her to lose her baby in the previous pregnancy.  And, the bad news did not stop there. Lauren was also told there was a high probability this baby may have a rare genetic disorder.

“This couldn’t be happening again,” explains Lauren. “My husband and I were already contemplating hard decisions we might need to make in the next few weeks. But we weren’t ready to give up.”

Lauren was immediately sent to Dr. James Hill, a high-risk maternal fetal medicine specialist at the Center for Maternal and Fetal Care – Westover Hills, which is a program of The Children’s Hospital of San Antonio. Lauren would have frequent labs drawn and doctor visits. “My heart rate would increase significantly, and he monitored my heart medications closely. He also noticed I needed to be put on thyroid medicine,” Lauren explains. “The medicines really helped me to feel better. He wanted to make sure I was being treated. His concern about my health and my baby’s well-being made me feel so cared for, and the fact that Dr. Hill immediately jumped on it was so comforting to me.”

Dr. James Hill is a maternal fetal medicine specialist at The Children’s Hospital of San Antonio. Lauren was amazed by the genuine care he provided to her and her baby.

Because of Graves’ disease and the possibility that her baby could have Graves’ and another rare genetic disorder, Dr. Hill referred Lauren to Rachel Ault, a genetic counselor at The Children’s Hospital of San Antonio. Rachel walked Lauren through all the possibilities and recommended an amniocentesis that would be performed when Lauren was 16 weeks pregnant to test for fetal abnormalities. She gave Lauren a lot of information about what to expect and reminded her that she should not blame herself for what was going on.

“At this point, everything felt like a whirlwind. I was so scared and having to wait for the amnio procedure and then for the results was excruciating,” adds Lauren. “Dr. Hill was amazing during this time. He prayed over me and prayed over the baby. He calmed me and told me to have hope. I have never had a doctor that was so invested in me. I knew I could put my faith in him, and he would take good care of me and the baby.”

On August 24, Lauren nervously walked into her amnio procedure. Dr. Hill and another doctor performed the procedure.  Lauren remembers how the baby’s head was near the needle and remembers Dr. Hill telling her that the baby looked good on the ultrasound. A glimmer of hope Lauren thought. During this procedure Dr. Hill identified that Lauren had an anterior placenta which made an extra layer that the needle would need to push through before getting into the amniotic sac. For Lauren, this meant that there was an even higher increase of miscarriage and that the cushioning may make it more difficult to feel her baby kicking. Dr. Hill assured her he was confident that he could safely perform the amnio procedure – and he did.

Now the dreaded waiting period began. Lauren would have to wait two to three weeks for the results of the amnio. These would be the longest weeks of Lauren’s life.

“Every night I cried waiting for the results,” remembers Lauren. “While I was waiting, I was calling around getting quotes for a funeral and at the same time doing lots of research on raising a special needs child, if the child would survive.” Lauren’s husband, Bobby, would remind her every day to hold onto hope, not to give up and have faith. He was her biggest supporter during this tough time for their family.

Lauren had still not told anyone about her pregnancy and had been going through all of this alone, but she decided to share the news that she was pregnant with a few of her mom friends at FIT4MOM Alamo Ranch/Helotes, a fitness business geared toward moms which she owns. She knew she needed all the support she could get right now and what better place than with the women who were part of her community.

Lauren will never forget when the call finally came in. It was a Friday at 4 p.m. and she was 19 weeks pregnant.

“I answered the phone and it was the genetic counselor, Rachel. I heard her say, ‘Your baby is healthy!’ She doesn’t have the rare genetic condition,” remembers Lauren. “I fell to the ground and held my stomach. For the first time, instead of feeling completely detached from this baby, I felt like I would actually be able to hold and kiss my precious baby’s head. You go from planning a funeral for your baby to then hearing the best news ever that you get to hold your baby.”

Rachel Ault is a genetics counselor at The Children’s Hospital of San Antonio. She gave Lauren the good news about her baby’s genetic testing results.

It turns out Lauren’s placenta was the carrier of the genetic disorder which happens in two percent of pregnancies. Lauren’s baby had a 95 percent chance of having the condition. Lauren was now looking at what she explains was a miracle baby and one she would name Kacey Hope to represent the hope she was reminded to hold onto throughout this scary process.

For the first time in months, Lauren was able to breathe. She finally announced she was pregnant to her family and did a gender reveal two weeks later with her FIT4MOM group. Her kids, Andi and Cody, were beyond excited to learn they would be having a baby sister.

During this time, she would see Dr. Hill every two weeks to get tested for her thyroid and as Lauren approached her third trimester, she was seeing Dr. Hill weekly. “I still had a hard time accepting that everything was alright. I was so worried this baby was somehow going to be taken from me. Dr. Hill would remind me often to have hope and reminded me to enjoy my pregnancy,” said Lauren. “The ultrasound technicians would also reassure me during my appointments that the baby was growing well, and not showing signs of any disorders.” Her measurements looked great, but the best thing Lauren appreciated during the appointments was getting to hear her daughter’s heart beating.

Thankfully, Lauren’s third trimester was not as eventful as the second trimester and she started getting more comfortable with the pregnancy and the fact that this baby would arrive safely. Lauren almost made it to her due date but ended up delivering Kacey on February 3, four days before her due date.

“On delivery day the baby came fast and there was no time for an epidural. I was used to very long labors, but she had her own agenda. She wanted to enter this world quickly and the nurse and my husband almost had to deliver her. Luckily, the doctor on-call arrived just in time. The first moment I looked at her I could not believe she was really here. I heard her cry and I felt this sigh of relief. After all the trouble we went through and her five percent chance of being here, it was truly a miracle to see her and touch her. It was almost as if everything that happened, never happened.”

Looking back at her pregnancy journey, Lauren is grateful for the dedicated care Dr. Hill provided and how closely he watched over her. From the diagnosis of Grave’s disease to monitoring her heart condition to identifying she had placental lakes, a rare condition where the placenta has pools of blood on it, Dr. Hill was monitoring Lauren closely.  “These are conditions that can easily be missed which is why I am grateful I found such a competent high-risk doctor to not only take care of my baby but to focus on my health as well,” said Lauren.

“Every week I would come and see the team at The Children’s Hospital for my appointments. It became a very familiar and comfortable environment,” remembers Lauren. “I have never had that much interaction with a medical team who seemed to really care about me, and this was something I truly cherished. I do not have the right words to thank them for their care. Now that Kacey is here, it sounds crazy, but I actually miss seeing them.”

Kacey is now a happy 2-month-old baby and Lauren is enjoying every second with her. What started out as one of the scariest times in her life ended with such a beautiful miracle and Lauren is happy she was able to find the right time to tell her story. Her hope is that her story will help other moms advocate for their own health and find the right doctor to care for them along their own pregnancy journey, like Dr. Hill did for her.

If you experience any complications during your pregnancy, please talk to your doctor about a referral to the Centers for Maternal and Fetal Care. We offer three convenient locations with a team of compassionate and experienced physicians. Visit our website for more information at The Children’s Hospital of San Antonio Centers for Maternal Fetal Care.

April 16: Wolf-Hirschhorn Syndrome Awareness Day

Candice Chapman, Amazing Mother and Fierce Advocate

Wolf-Hirschhorn syndrome. Something we had never heard about before May 2015.  It’s a phone call I will never forget receiving. I remember sitting on our living room floor and playing with Hadley, who was 10 months old at the time, when my phone rang. It was our amazing genetics counselor, Kimberly Nugent, calling from The Children’s Hospital of San Antonio. She informed me they had received Hadley’s genetic testing results and told me her diagnosis.

Genetic testing showed that Hadley’s had a “small deletion” – meaning a small sequence of DNA was missing. Although Hadley would have delays in reaching her milestones, Kimberly said my daughter would be able to develop, it might just take her a little bit longer.  I couldn’t hold back the tears and she could hear the fear in my voice.  The fear of the unknown.  She told me not to research anything that we would go over the results at our appointment. Of course, the first thing I did when we hung up was research it!  What I found made me cry even more, I sat there holding this beautiful child of ours, worried about what her future would be like.

After meeting with Kimberly and Dr. Scott McLean, a clinical geneticist at The Children’s Hospital,we had a game plan and got to work doing what we could to make sure Hadley received all the services she needed.  We have been blessed to have such an amazing and caring medical team from the beginning.  When you have a child with a rare syndrome like Wolf-Hirschhorn syndrome it is hard to find doctors that will see her because they aren’t familiar with the syndrome.  We have learned that we have to educate some of the doctors we see and that is completely fine with us, that’s even something we were told in the beginning.

Watching Hadley’s determination to meet milestones is amazing. She doesn’t give up and pushes hard to accomplish anything she sets her mind to.  She continues to prove doctors wrong by doing something they didn’t think she’d ever be able to do.  She is small in size, but she is so strong.

Having a child with a rare genetic condition has been anxiety provoking at time. Seeing Hadley in the hospital because of seizures or learning of another diagnosis that may or may not be related to Wolf-Hirschhorn syndrome is scary, but the good times have definitely outweighed the bad.  We have learned to take each day as it comes, enjoy all the small things, not to take anything for granted and to know that she will do anything she sets her mind to.  Hadley is so inspirational to so many people and we are so blessed to be her parents and to learn from her. 

With any diagnosis you get for your child, there is always that moment of the fear of the unknown, but just know that there is always someone, somewhere that you can reach out to.  We found an amazing support group on Facebook and have been fortunate to grow very close to many of the families.  It may feel like you are alone at times, but remember you never are alone.

If you believe you or your child may have a genetic condition, ask your doctor for a referral to the Genetics Clinic at The Children’s Hospital of San Antonio. Testing and counseling services are available for both adults and children. Genetic counselors, like Kimberly, help families find answers and identify the resources they may need in terms of support and medical treatment.

Our Physicians’ Ongoing Effort to Combat Maternal Mortality

Maternal mortality is not a subject that is easy to discuss, but it is something that is critically important to get a handle on. Maternal mortality is defined as any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

According to the American Journal of Managed Care (AJMC), among 11 developed countries, the United States has the highest maternal mortality rate and maternal deaths have been increasing in the United States since 2000 and according to a new report from the Centers for Disease Control and Prevention, maternal mortality in the U.S. increased by more than 15% in 2019. The surge occurred as the country was on the brink of the COVID-19 pandemic and its disruption of traditional medical care. The report also confirmed that Black women still suffered from the highest rate of maternal mortality when compared with white and Hispanic women.

Although 700 pregnancy-related deaths occur each year, two-thirds of these deaths are considered to be preventable. The most common causes of pregnancy-related deaths are heart disease, high blood pressure, diabetes and other chronic conditions and is seen predominantly in African American and Hispanic women.  Although women are dying each day of these conditions, these deaths are largely preventable with two basic services: access to health coverage and prenatal care.

These statistics are heartbreaking which is why physicians from around the country are coming together to turn these numbers around. Our team of experts at The Children’s Hospital of San Antonio have been leaders in Texas in ensuring a safe delivery for both mom and baby. Below are just a few examples of programs this team has introduced to curb these numbers.

  1. Practicing For Patients:  This is a national program whose development was led by Dr. Shad Deering and the American College of Obstetrics and Gynecology (ACOG) Simulation Working Group in collaboration with the Patient Safety Council for Women’s Health Care.  It was created to allow every size hospital the ability to conduct simulation drills on their labor and delivery unit in order to better care for women who experience a postpartum hemorrhage.  Dr. Deering, Dr. Brook Thomson, Dr. Carey Eppes and the TexasAIM team worked together to provide instructor courses to over 120 hospitals across Texas in 2020.  As the pandemic accelerated, a virtual instructor course was created and additional hospitals were trained in Louisiana and Maryland to provide these life-saving tools.
A prepandemic simulation training focused on training doctors and nurses to stop a postpartum hemorrhage.
  • 2. The Children’s Hospital’s Department of Obstetrics and Gynecology received a five-year, $2 million dollar grant from the Agency for Healthcare Research and Quality (AHRQ) to develop a national program to train doctors, nurses and paramedics on how to save pregnant moms who experience cardiac arrest. This program is desperately needed as current training programs have little to no information regarding this vulnerable population. 

Obstetric Life Support (OBLS) is a simulation-based curriculum designed to promote the key components and unique approaches necessary to treat maternal cardiac arrest effectively. In addition to creating content for both first responders/paramedics and physicians and nurses working at the hospital, the team has worked with Laerdal to create a new simulator designed specifically to represent a pregnant patient that requires resuscitation.  These tools will enhance the care of pregnant patients who experience cardiac arrest and overcome some of the current barriers to quality CPR such as not knowing where to place hands for compressions or AED pads because of a woman’s breasts, or how to perform left uterine displacement to improve blood flow to the fetus.  After OBLS, providers are prepared to immediately start CPR without fear of harming the patient or fetus with the goal of improving survival rates for women experiencing cardiac arrest.

  • 3. In addition to the course being developed, a recent virtual meeting was held with an OBLS (Obstetric Life Support) Core Team that included attendees from across North America and Norway. This group was formed to develop a curriculum to resuscitate pregnant women experiencing maternal cardiac arrest. Participants evaluated in-hospital and out of hospital simulation scenarios, megacode checklists, and pilot testing data summaries. Using a standard-setting methodology called Angoff, they established the minimum passing scores for participants taking the course. Participants also discussed manual edits and how to best engage our learners. Future meetings are planned to continue the discussions.

To commemorate this important work, the Office of Governor Abbott issued an official proclamation to make January 23, 2021 the inaugural Texas Maternal Health Awareness Day to bring increased awareness to the importance of maternal health.  A committee was also put together at the state level to continue to watch and provide research in this important area. The committee published a biennial report in September 2020.

There is so much more work to be done to combat the staggering maternal mortality statistics. The physicians at The Children’s Hospital of San Antonio are committed to putting programs in place to educate the community as well as to work closely with physicians from around the country to create  collaborative training programs. Together, we will make an impact and stop these deaths that are highly preventable among the women we care for.