Friday, March 5, 2010

The Last Great Marathon

I guess now is as good a time as any to describe my labor with this last baby, my 4th child and 2nd daughter.

First of all, I think that I should share my birth plan with you. Well, I won't share it word for word, but here are some of the requests I made in my plan (which I respectfully entitled my "Birth Requests" just to show I was level-headed):
-No IV or heplock unless medically necessary
-A quiet, peaceful atmosphere in which to labor with my husband
-Please don't offer medication. I will request it if I need it
-Only intermittent fetal monitoring unless continuous monitoring proves necessary
-No episiotomy unless there are signs of fetal distress during stage 2, and please allow me to try pushing harder if needed

Well, you get the picture. I wanted the most natural, lowest intervention birth necessary. I was convinced that the less intervention I had, the more I could relax and enjoy my labor.

The funny thing is, I'm not a very relaxed person. :) But seriously, I had never labored before without an IV and continuous fetal monitoring, and I was surprised at how much I'd come to depend on having a machine count my contractions and track my baby's heartbeat for me. It was so strange to have all of that freedom.

I guess I should backtrack and just describe what happened. As I stated a few posts ago, I was scheduled for induction on Wednesday, February 17. I was not excited about this. I knew that an induction would be a final farewell forever to my "dream birth." (Well, actually, my dream birth is a home tub birth, but oh well...) Anyway, I called the midwife on call on Tuesday the 16th and asked her what would really be the safest option for me. Should I a) just keep waiting to see if I start naturally soon and potentially go over a week past the due date, b) see if getting my cervix stripped could start me into labor so I wouldn't need a Pitocin induction, or c) just face the induction. Both she, the midwife on call (I'll call her Midwife C, my favorite in the practice) and the midwife scheduled for Wednesday were absolutely wonderful. I knew that with either one of them I could trust that I'd have their full support to labor as I wanted to. I knew that I wouldn't need to feel like I was auditioning - they wouldn't panic, even if I did. I was straight-forward with Midwife C about this, that I wanted either her or Midwife R (scheduled for Wednesday) to deliver my baby. I let her know that my comfort level dropped on Thursday with JB was back on call.

And frankly I was in pain. During those final weeks of pregnancy, my daughter's stretches and kicks weren't just uncomfortable - they were frighteningly painful. Her head was so low and hitting a nerve, and at times I would completely lose my footing and almost fall to the floor. It was sudden, sharp, and frustrating. I swore a lot in those weeks. Also, I felt a deep burning pain just behind my pubic bone (sorry to be graphic, but hey, it's pregnancy). I could tell that her head was right behind it, and walking was terribly comfortable.

I was ready to be done with my pregnancy, and I was willing to be induced on Wednesday if it meant a sooner birth and a better provider. Still, I wanted one last shot at a natural, low-intervention birth. So we agreed to have my cervix stripped. I hurried to the office, underwent the very uncomfortable procedure, and found out that I was dilated to about 5 centimeters. Midwife C was pretty hopeful that she'd see me later to have a baby. I was pretty hopeful too, but I had waited so long and had started losing faith in my body. So it was hard to relax or get excited (which I wanted to avoid anyway, because I feared that adrenaline would undermine any contractions that might start).

During the hours that followed, I experienced occasional, mild to moderate contractions. I'm not very good at timing contractions, though, so I couldn't tell you how far about they were. Besides, I was too busy doing other things. My sweet husband, hoping that we were set for a labor and feeling antsy about being at work when I might start quickly, opted to work from home that day. He helped out with the boys while I nested lightly and tried to stay mildly active without wearing myself out.

By dinner-time the contractions were stronger and a bit steadier, but I still hadn't gotten around to really timing them. They seemed inconsistent. I did start to feel, however, that I wanted to rest and relax through them instead of being on my feet. My husband cleared the table, called his parents to let them know that we thought we were probably starting, and worked on putting the children down for the night. At around 8ish, the contractions reached a new level, and I needed to use the bathroom. As I sat on the toilet, I noticed the faint smell of blood and looked down see a bloody show. It wasn't scary, but it was something new. I decided to step into the shower. This was probably it. Now I needed to focus on relaxing.

My husband checked on me in the shower, and I said that it was a good time to call his parents. He picked up the phone and found a voice message from his mother saying that his dad was on the way in case he was needed. He called her and let her know that the timing was perfect.

Now we packed the car and waited for my father in law, and suddenly the contractions started to slow down, though they didn't weaken at all. As I feared, excitement (even my mild, apprehensive excitement) was slowing the labor down. I shared with my husband that felt silly and wondered if we were moving too quickly. He said that he felt that it was the right time. We had prayed that we'd know when to go to the hospital, and he felt confident that now was the time. So we moved on.

In the car, I tried timing contractions (I'd done a little bit while resting - they were somewhere around 4-5 minutes apart). This time the contractions were stronger, but the position I was sitting in made them seem more mild. I can't explain, but I can tell you that I like to labor sitting up. :) I called the midwife, and the next contraction came about 3 minutes after the previous one had. She said that was timing she could work with and said that she looked forward to seeing us. (As I turned out, she delivered at least 3 or 4 babies that day!)

We arrived at the hospital and rode the elevator up to the labor and delivery unit. I was brought in to triage for 10 minutes of monitoring and a cervical check. I was hoping for 7 centimeters, but I was only at 6. Still, that was something. They don't usually send you home at 6 centimeters. While I was trying to find a comfortable position during the monitoring, the probe kept getting off track. (This should be a good reminder of why continuous monitoring can be such a pain. Too much movement makes for messy readings, and that can make people anxious). My husband and I were joyfully marveling at the steady chug of our daughter's heartbeat, which sounded like horses' hooves on a race-track. My husband made a joke and asked whether I was ready to deliver the race-horse that was with the baby, and I couldn't stop laughing. The monitor contractions showed some pretty spiky readings for the next few minutes from my belly shaking. Finally I was released from the monitor and brought to my room. I quickly used the bathroom, changed clothing, and started moving around. Then I decided to fill up the tub while my husband got our stuff from the car. I enjoyed sitting in the tub for awhile, where I noticed that the backpain which came with each strong contraction seemed to be muted somewhat.

It might have been wise for me to stay in the tub, but when my midwife visited and checked on me, I realized that I had no idea how far apart my contractions were and it was hard to tell how strong they were in the tub too. She suggested that I turn on the jets and see if the bubbles could stimulate the nipples and make my contractions get stronger. It worked like a charm. In fact, the contractions that came with the jets on were intense and almost scarily close. I went from what I am sure was 3-4 minutes apart to maybe 90 seconds to 2 minutes apart. It was erratic. I started to think that it would be wiser to get out soon.

I toweled off and proposed that we go for a walk. I was given a second robe to cover my backside, but after taking about 4 steps into the hallway, I realized that I was in no condition to walk. My contractions required rest.

I came back in and sat on the bed. I admitted that I was frustrated about keeping track of my contractions. The uncertainty was getting to me - I was so used to a machine doing the work and letting me know how far along I was. My midwife offered to check me and I accepted. I was now at an 8. The contractions, though somewhat inconsistent, were very strong. In fact, right after the tub, I had a couple of contractions that literally came immediately one after the other.

As I expected, the deep back pain which came with my previous labors was there again. This time it seemed stronger and more intense, and the fact was I was finding it very hard to really relax. I mean, ideally I should be on my side or slightly reclined and letting my whole body go. But the backpain seemed to intensify beyond anything I could handle when I was on my side. The only thing that I felt that I could handle was being upright. I was focusing on relaxing my lower body while I was propping myself up with my arms. It was crazy, I could tell. But at this point the contractions were too strong and too frequent to request a birthing ball or something.

Midwife C was so awesome. She just supported me through it and told me what a great job I was doing. I didn't feel judged for not being more relaxed or better prepared. I just worked through each contraction sitting up with her directly in front of me encouraging me. My husband gently massaged my back between contractions and pushed hard on my lower back during contractions. The burning was so intense. I focused on deep breathing and visualizing my uterus and my cervix. I could feel and see the muscles doing their work.

It was very painful. So painful. Painfully humbling, and yet I knew that I was in transition and that I was a matter of minutes before I'd be pushing out my daughter. I started to feel pressure and an urge to push even though my water hadn't yet broken. The midwife said that I could grunt a bit with the next contraction, so I did, and I was convinced that my water broke when liquid started gushing out. She looked and said that it was just urine, but then she reached in to check the bag of waters, and it burst immediately. I just started pushing at that point.

Now, for some reason I remember that when I was pushing my boys, I didn't feel a whole lot of pain between contractions. Something about the way my daughter was positioned made this much more painful, and I didn't really feel like I could or should rest and only push with contractions. There was intense pressure and that continued burning pain in my abdomen. Unfortunately, I was sitting so far forward that the baby wasn't going to progress in that position. She they got me slightly reclined back at a 45 degree angle, and I pulled me legs back and pushed with all that I had. I wasn't screaming, but I was moaning and wailing the whole time. It was a whole new experience.

The baby had really worked herself up into an interesting place. As I had suspected, her head was right behind my pubic bone, and the midwife was literally reaching up and pulling her head down (almost digging her out) to where she could be birthed. I just kept pushing, and thank goodness people reminded me to take some breaths and pace myself. As the baby started to crown, I felt that familiar sting and pull. But I had not opted for a mirror this time, and I'm glad I didn't. They announced that the baby was crowning, and I continued to push hard. Then my midwife yelled at me to slow down a bit. :) She want to save me from crowning. She told me to gently grunt the baby out, and I could hear here announce that the head was born.

Then I did something naughty. I pushed again. I could feel the rest of the baby's body still inside me, and the pressure was so strong and the burning so intense that I didn't wait for coaching. I just pushed, and her body slid out. I immediately felt a stinging sensation, though, that was too familiar - the feeling of a perineal tear. I knew it, but it was okay. The midwife had tried, and I was the one who didn't wait for coaching. Happily it was just a 1st degree tear again.

And there was this lovely little person on belly at that point. The fluid had actually been a bit yellow, showing slight signs of her having passed mechonium. But they examined her on my chest and suctioned her out a bit, and she was fine. She had ingested a bit, but not much. And she was pink.

And then she pooped on me. What a funny thing to have happen to you! Though, after having pushed a baby out, you really don't care that someone has pooped on you, especially when they are small and beautiful.

I was so amazed that she was there, and I tried to cuddle her. I was humbled by my pain, though. It wasn't in a way that made me feel cold toward the baby. It was just a deep, humbling ache in my body. And it was such a relief to have her outside of me for a change.

My husband and I were overjoyed. We were also tired. After the placenta was delivered (again, I was a little hasty and pushed it out before the cord even stopped pulsing - I just wanted to get everything out of my body!) and my tear was stitched up, the room started clearing out. My midwife had another labor to attend in the same hospital. My husband and I were left with our little one, and I offered her the breast. She latched on well (though I didn't do an amazing job making it a painless latch for her). She nursed both sides for awhile, and I immediately met a new pain - nipple soreness.

We really enjoyed our bonding time with her, but I have to admit that my husband and I hadn't realized until then how tired we were. I nursed her again, and eventually they took the baby down to the nursery where my husband assisted in and recorded the baby's first bath.

I was a bloody mess, though I did enjoy using the bathroom. It really is a great feeling to relieve your own bladder after a birth. I was transferred to our room, and soon my husband arrived with our cute little one with the round head and the slightly large ears. She's beautiful and sweet, and she's has a sensitive little soul. I can tell. I don't know if she'll eventually become as rowdy as her siblings are.

About the hospital stay: The staff was great, but hospital stays are so not restful. It seemed that every time I dozed off after awhile, someone came in for a blood-pressure check or to change the garbage. Some nurses were nice enough to turn off the computer monitor, but most forgot. I was glad to have three pillows from home to stack up around my head and block out the light.

So that was it. No painless birth for me, but that's okay. I didn't expect it. In fact, I think there was a part of me that wasn't willing to trust and give in to the labor until I felt that the contractions were truly painful. Then I could work at relaxing against them to minimize the pain. It might not be the smartest way to have a baby, but it worked for me.

And I'm so grateful to be done. No, I haven't had surgery. We don't yet know that it would prove necessary. Hopefully other reliable forms of birth control will be...well, reliable (and not detrimental to my physical or emotional health). Still, we feel that our family is complete.

And now we are in the throws of chaotic life with a newborn. She's lovely, but someday I want my bed back. And my breasts, and some sleep. :)

(Again, I think I'll post this unedited for now in case a curious friend is anxious to get the scoop. Thanks for reading!)


  1. good job marathon Mommy!you did a great job and endured!!!!

  2. Thank you for sharing your story! I was so curious!! And I'm so glad you got the midwife you wanted! (I think I know who you were talking about, and if so, she was my favorite, too!) You did it!!!!

    "So that was it. No painless birth for me, but that's okay. I didn't expect it." I think that was my problem-- I had come to expect a pain-free birth so I was surprised when it wasn't... I know, bogus, right? You rock!!!

    I wish you continued luck with nursing!!