Tuesday, March 22, 2011

A birth story

Today is the first anniversary of Julia's birth. I'm overjoyed to have the memories of this past year, but the memories of the birth itself have weighed rather heavily on me. It's what I tend to think about when I lay awake at night, and here is the story.
We sought the care of midwives, because I thought that would be the best way to get the sort of care I wanted. I didn't want a typical hospital birth. I wanted no drugs, and no drugs to be a simple request away. I didn't want to be hooked up to a fetal monitor, and I definitely didn't want to be epesiotomied or to have a c-section. If possible, I wanted to labor in a tub and have the option of a water birth. The midwives suggested that I write a birth plan, but I, rather naively, ignored that suggestion, thinking that their wishes would be in line with my wishes. They provided good prenatal care, until about my 39th week, when they said that the baby was posterior, or face-up. This is not necessarily concerning, as the baby can flip to the correct face-down position at any time, but they did suggest I spend time on all 4's, supported by pillows, and to spend as much time resting on my left side as I could, for the benefit of my suddenly slightly elevated blood pressure. I did these things, napping on my left side, and spent 5-10 minutes at a time on all 4's, but after the fact, I did some research and found a lot more things I should and should not have been doing. For instance, I went swimming, to exercise and relax and feel weightless again, but I should not have been doing the breaststroke, which encourages the baby's head to settle down lower, making turning less likely. I also spent time squatting, having read in many books that it is a good position for pregnant women to be in. That also encourages the head to settle. I should have been spending hours and hours on all 4's, and even spent time in a inclined position with my butt higher than my head to encourage her to float higher and turn. I could have sought a manual turning of the baby, (by a trained professional pressing on specific parts of the belly.) I could have gone to see a chiropractor, to see if being adjusted would help the baby to turn. I should have avoided being reclined on my back (like I was in the car for the 65 minutes it took to drive to the birth center) and instead labored in specific positions to encourage turning. Now that all seems pretty obvious to me, but at the time, I presumed that the baby would turn when she needed to and that it would all be fine, so I didn't research it, and didn't think about it. On the 21st, I had felt some contractions, but they were not painful, and I thought it likely that they were false contractions. That afternoon, I did think to mention it to Dave, who got a tad worked up that I hadn't told him sooner, but I was pretty unconcerned, since my due date was the 24th, and tons of people told me that "the first baby is ALWAYS late." They also told me that the first labor was usually long too, so the general advice was wrong on two counts. My sister Caroline was visiting, and our friend Lee. Caroline was going to drive back to her college the next morning, but stated that if I was actually having the baby that she wasn't going anywhere. Lee stated that he wasn't really keen on participating in the birth, so if we left, just to leave him a note. That evening, I noticed some mucus tinged pink when I wiped after one of my many trips to the bathroom, and thought it was probably my mucous plug coming out. This isn't necessarily a sign of immediately impending labor, but I decided to call the midwives anyway. I got ahold of the one who was on call that night, but she told me that she was coming down with something, and not to call unless I was REALLY sure that I was in labor so that she could get a good night's sleep. Now I think back to that and wish I had asked her to turn me over to the other midwife's care, since it seems possible that her job performance was affected by being sick. However, I worry much to much about pleasing other people and not making a fuss, and so I agreed, and went to bed. about midnight, I got up to go to the bathroom, and when I was climbing back into bed, I felt a small pop, and a small gush of fluid. Maybe a cup full. I sat there a minute, a little bewildered, before realizing it was my water breaking. The midwives has told me to call if my water broke, so I woke up Dave, and went to call. I didn't have any contractions at this point, so it was sort of weird to know that I was in labor, and that the baby would be here soon. No extra 15 days of pregnancy for me. My midwife told me to go to sleep, and to call again when things were picking up, meaning contractions were about a minute long and 5 minutes apart. I went back to sleep for a couple hours, and by 3 30 am or so, I was feeling contractions pretty solidly. I didn't want a lot of commotion, so I went upstairs with a clock and a piece of paper, and timed things myself for a bit, but it soon became apparent that contractions were 30 seconds long and 2-3 minutes apart. It was feeling pretty intense at this point, so I woke up Dave and Caroline, and Dave called the midwife again. She told us to go ahead and start driving, since we had an hour's journey. Dave and I got into our new Subaru and Caroline followed in her car. About 20 minutes along, and a deer ran out into the road. Dave braked hard, but the deer ran by. He stared to speed up again, and at the last second, the deer turned around and jumped in front of the car! Dave said some colorful things, and jumped out to see what the damage was. The deer ran off somehow, leaving a good chunk of fur behind and a dented fender. Things looked drivable, and I was still in labor, and moaning pretty loudly, so we kept going. The what-ifs of that moment alone are incredible. We were in a extremely isolated stretch of road that had no cell phone reception.  What if Caroline was not following us, and we had been alone? What if the car had been un-drivable? What if one of us had been badly hurt? I try not to think about that, really. We got to the birth center about 4, and I was in such a introverted, intense state of mind that the outside world was pretty much lost on me. I got inside and made a beeline for the toilet dropping my pants along the way. The midwife suggested that I move to the bed so they could check and see how I was progressing, so I flung myself down, butt in the air and could have cared less who was seeing the show. There were two midwifery students who were actively hands-on-learning, and I can't remember either of their faces. I do remember that the tub had been filling with water, and I remember asking twice if I could get in yet, but somehow that request was never accommodated, and I was soon too far gone from reality to remember that my own birth wishes included laboring in the tub. After my butt-in-the-air-contraction was over, the midwife asked me to turn over so she could see where we were. The checking showed that I was 9 cm dilated. 10 cm is considered fully dilated, so it looked like my labor was barreling along and that the baby might be there quite soon. I soon felt the urge to push, and then my brain was really gone. I was lost in the intensity of the pushing, and between contractions I tried to relax as much as I could, to help manage the pain. Time passed, and I stayed on my back. My logical mind knew that the back was the least helpful position for a woman to labor in, but my logical mind was far away, and the idea of voluntarily moving seemed impossible. I do know that eventually the room was bright with sunlight, and somehow I became aware that I had been pushing for about 4 hours. At this point, the midwife suggested we try a birthing chair, which I found to be incredibly uncomfortable. I then moved to the toilet, which was way comfortable, but shortly, the midwife asked me to go back to the bed so she could check me again. (I wonder why she didn't check me right there.) Very soon after moving back to the bed she offered me a nasty tasting herbal concoction, but I can't remember what it was supposed to do. Perk me up, probably. Soon after this, she said that the baby was still posterior, and since my labor wasn't going anywhere, she brought up the idea of transferring to the hospital. I wasn't able to ask questions that I normally would have, or I would have asked what she could do about it, what was likely to happen at the hospital, what our options were. Instead all I could think was that if we had to go somewhere, I wanted to get there fast, before things got worse. Someone put pants on me, and I somehow got out the door and into our car. I don't know why the midwife didn't put us in her car, but I do know that Dave was pretty white-knuckle about the drive. I felt like there was a bowling ball poking out of my butt, so there was no way I could sit on a seat. Instead I kneeled on the seat with my butt to the windshield and I have a clear memory of the seat belt warning dinger going off repeatedly, but did not have the mental capacity to fasten the seat belt beneath me to stop it. I also have a clear memory of the oddness of seeing people driving normally, doing normal thing, while I felt like my world was out of control. We got to the hospital, and pulled up to the emergency room entrance. Instead of being met with orderlies, like in the movies, we had to walk ourselves in, and I remember leaning on one of those retracting line-forming railing posts, pushing, while I could hear the counter attendant asking Dave questions like "are you the father of the baby?" and "are you two married?"  It was so surreal. There were tvs blaring the news that Obamacare had passed, but I was so self-absorbed that I didn't learn about it until much later in the day. The midwife brought a wheelchair up, and since I couldn't sit in it, I kneeled while we went on what felt like a tour of the hospital. When we got to the delivery room, it was a buzz of activity. People took off my clothes and put on a gown, they got me into a bed, and attached a fetal monitor to my belly, and someone put in an IV for pitocin. We hadn't been there more than a couple minutes before the doctor arrived, and she told me that she was going to reach in and turn the baby. And she did, which was VERY painful, but everything else was so painful too that it didn't really register that much. I do remember thinking that all I wanted was for the baby and the pain and everything to all just go away. Then the doctor and all the nurses were telling me to push, and that the head was crowning. Someone held a mirror at the wrong angle, so I couldn't see it but I could feel it. The head came out, then the whole baby was there, on my stomach. It was truly surreal. I knew that I should be feeling happy, but I really just felt a fuzzy sense of relief but I did things like smile at my husband (who was crying) and look at the baby. She looked huge to me. Her head was pointed from the extended time in the birth canal, and she was kind of purply greyish. Her eyes were dark, and sort of swollen, and she had a lot of dark hair. She stayed on my belly for a little while. I don't know how long, really, but I think the doctor said that she would have thought I had an epidural from how well I had managed the pain and I think the midwife offered the comment that we were lucky to get the doctor we did, because anyone else would probably have given me and episiotomy and vacuum extracted the baby. Then the midwife left. I did have a small tear, and they put in two stitches. They also kept pressing hard on my belly, which hurt a lot, but served to help my uterus contract properly. I think I tried to offer a breast to the baby, but I don't think she really nursed at all. They took her over to be weighed, and since she was 8 lb 15 oz, they said she was at the edge of the "normal" limit and had to be tested for gestational diabetes. I was still not in my right mind, or I would have protested. I was 8 lb 14 oz, and Dave was over 11 lbs. We would naturally have a large baby. Getting tested meant heel pricks, and she cried. A nurse came with a bath cart, and right-minded me would have protested that too, since amniotic fluid scent helps a baby to nurse and bond, and the cottage-cheese vernix left on her skin could have been rubbed in to keep it moisturized. But shell shocked me was fine with the idea of a bath, and Dave was helping, so the bath happened, and she cried. The blood test established her glucose levels and the nurse told me something like that if it didn't go up in the next half hour, she would have to have a feeding of formula. Another heel prick, and I guess it was decided, because while another nurse was having me stand up and walk to the bathroom to see if I could pee, someone else was sticking a tube down Julia's nose and putting formula in her belly. I can't believe that I didn't protest that. I don't even know if I could have refused. The midwife was gone, and when you are in a hospital, they act with an air of authority that is very very hard to question. Julia promptly spit up that formula, which secretly made me pleased, and somehow her blood sugar tested fine the next round of pokes, so we were thankfully done with that ordeal. We moved to a recovery room, and recovered. Julia slept and nursed, which I was anxious about. Was she latching properly? A lactation consultant peeked and said she looked fine, but I was still anxious. This was something I planned on the midwives helping with. At some point, my midwife had told us that since we were now hospital patients, they wouldn't do the postpartum follow up visit at home on day 2, or day 10. They could see us for the 3 week check up, but in the mean time, we had to find a pediatrician for follow up care. We stayed the night at the hospital, and thankfully they let Julia room in with me. The next day, we were free to check out, and to help us do so was a hospital volunteer. But first, she told us, we had to bring in the car seat to make sure she fit it properly. This was a little interesting, since I found the car seat manual to be a bewildering piece of literature, I had found a trained fireman to install it for me. Dave had been up in the village while I was figuring out that project, and so he had no experience installing or uninstalling it, and for him to have to go out and uninstall the contraption ended up involving cutting something. We didn't buy one of the typical bucket seat style that detaches from the base. Figuring that Julia would have outgrown it before we left the village, we bought a large "convertible" car seat that was supposed to fit her for many years. Our new car came with The Latch System which turns out to be an incredibly poorly designed system involving unseen latches way back in small crevices next to other latches that are incorrect, and the hooks you are supposed to hook onto the unseen latches are next to impossible to open once they have closed, especially in an unseen area of 1 inch x 2 inches. We have since switched to using the regular seat belt instead of the latch system, but in the moment, it was an exercise in frustration for Dave. He managed to get the thing inside though, and we dutifully put Julia in it, and everyone said that she fit. Dave picked up Julia in the car seat, and I sat in the wheelchair, and before we could get more than 10 feet, we had all the nurses in a commotion. Apparently we couldn't carry the baby out in that sort of car seat. Neither could Dave take her out of the car seat and carry her in his arms. He might drop her and sue. About 10 nurses had a back room huddle and eventually decided that I had to sit in the wheelchair and hold Julia (though they weren't  too thrilled with that, because what if I dropped her and sued?) Dave could carry the car seat and the volunteer could wheel us out. Dave brought the car around, and then the fiasco of re-installing the car seat ensued. The volunteer informed us that she was not allowed to help us install it for liability reasons, and so we drove off into the morning with a beautiful baby in what was likely an incorrectly installed car seat thanks to hospital bureaucracy.
That is the birth story. While I am absolutely happy and very grateful that I was able to have a drug-free vaginal childbirth and that our baby was healthy, I really wish that some things could have happened differently. I wish I had hired a doula. A doula's role is to support the laboring mother and to advocate for her wishes. I thought that Dave could take care of that, and while he was very supportive and wonderful, he was not at all experienced in labor, and I can't help but think that a doula would have filled some of the gaps that I perceived in my labor care.
I really wish I could have tried laboring in water.
I wish I had been able to ask the midwife to turn the baby herself. I asked about this at the 3 week follow up and I was told that during one of my pelvic checks the midwife tried very gently to see if she would easily turn, but that flipping the baby internally is on the border of what they are really comfortable doing. I can understand this, but in the midst of labor, there was no discussion about it being a possibility, and I really wish we could have avoided all the trauma of transferring to the hospital.
I also really wish that I had done my own reading up on posterior positioning, as there are many things I could have done that might have caused Julia to turn on her own, resulting in a much easier labor.
Finally, I really wish the midwives had done the 2 and 10 day follow up care. Even though breastfeeding went fairly smoothly, It would have been much less stressful for me to have skilled help checking up on me, and it would have saved us several long drives into Wenatchee for pediatric care and the stress of finding a pediatrician. (I didn't really care for the first one we chose, the one who came recommended by the midwives  and ended up switching to a much closer one in Chelan who was much more personable)
I am hopeful that as time goes on, I will dwell less on what was hard about the labor, and simply be grateful for the experience as it was. I hope that if I am to labor again, I will be better equipped to do so. I also hope that whoever reads this will take note of my experience and perhaps it will contribute to your own birth experiences. I am deeply in love with my daughter, and I am very glad to have her in my life.


  1. Thanks for sharing your story, Mary. Happy Mama Day to you! :)

  2. Thanks for sharing! I am so glad that you received mama-friendly/baby-friendly care at the hospital when you transferred! Like you said, any other Dr. may have used suction or forceps or even C-Sectioned you at that point, but your doctor helped you deliver naturally and that's awesome!

    That's so frustrating (and kind of silly) about the car seat commotion. Good grief! :)

    FYI, I posted my delivery story yesterday! Come check it out!