The Little One, Part 2: Birth

Well, this is long, but maybe you'll enjoy it!
 
I should start by saying that all my hopes and prayers were for a natural labour. Clint and I chose to go with a group of midwives for our prenatal and maternity care, but we were realistic that sometimes emergencies arise, so we chose midwives that deliver in the hospital. We went to monthly, then bi-weekly group meetings offered through the program, where we talked about what to expect in a normal, healthy labour. We watched videos of labours and births, we learned strategies to cope with labour and the medical interventions that might be necessary, and we chatted about our own hopes and fears.

My least favorite class was the one when we talked about c-sections. I have to admit, because of many reasons I was judgmental in my heart about women who have had caesarians. I knew that there are some genuine emergencies—my own mom had a blocked birth canal that forced her to have 3 c-sections—but overall, I saw it as “giving up.” I repented of this judgmentalism when I read this amazing blog post by a mom whose first son was born by caesarian [http://avital.blogspot.com/2011/01/cesarean-courage.html#axzz1WP8LvRqc]. But at the end of our birth group meeting on caesarians, which emphasized their seriousness, I looked at Clint white-faced and said, “I really don’t want to have a c-section.”

It was good for me to face this last fear. Once I confronted it full on, I was confident that no matter what happened, the doctors and midwives and doulas in our group would help lead me through a successful birth. This gave me peace and freed me from fear. I trusted my body and my care providers enough to do my job during labour: staying calm and focused.

Five days after the due date, when there were still no signs of labour, I pulled the door of my room shut and cried for several hours. One week after the due date, my cervix hadn’t dilated even a centimeter. But I waited until ten days after the due date to take a “labour cocktail” that the midwife recommended to help move things along. I wanted to give baby one last chance to show up before Clint’s parents and my sister Katie had to leave on Tuesday morning, July 5th.

I drank my apricot juice blended with almond butter, verbena oil and castor oil like a champ on Sunday morning after going to the early communion service, and laid down for an epic nap. I began to feel crampy (and cranky) in the afternoon, even resting through what I now know were early contractions, but even after a second dose in the evening, labour didn’t seem to be progressing. I called the midwife at about 8:30 pm and she said that she didn’t see why I should take yet another dose that night, it would be better to try to get rest and see the midwife the next day.

I look back now and laugh at what we did next because, I didn’t know it at the time, but I was clearly in early labour. Clint, Mom, Katie and I all went for a long walk. The funny part was that we started out heading to a spot about ten minutes away from our home, then I suggested we go to a park just ten minutes further, and the next thing I know we had walked nearly an hour away from home to my favorite bubble tea place, because I was craving it. I remember feeling some strong squeezes on the long walk home and thinking that maybe this crazy walk would get things going, but even though I didn’t sleep well through the night, the contractions seemed to fade away.

The next morning, Monday July 4th, I called to schedule a Non-Stress Test (NST) and Ultrasound, standard procedures for ladies 10 days overdue. After an afternoon of waiting and watching Mrs. Gaskells’ Wives and Daughters on Netflix, I grabbed my purse, told my mom and Katie we’d be back in like an hour, and Clint took me in for the tests. Both tests seemed to go well, and I was happy that my contractions seemed to be back and closer together.

But just about when I figured the tests were done and they’d let me go meet with my midwife, the NST tech got a call from the ultrasound tech. The ultrasound showed low amniotic fluid, so they wanted me to go to labour and delivery admitting to consult with an OB. At around this point the NST tech, a quirky middle-aged woman with big hair and a long flowy crepe dress in pastel colours, who had been chatting cheerfully with me before, decided that she wanted the baby’s heartrate to slow down one more time. It was the time of day when baby was normally really active, and my bladder was really full, so I wasn’t worried that she didn’t slow down, but the tech was persistent.

When she finally escorted us to admitting, I had to pee so bad I was nearly crying. They let me use a washroom there, but as Clint filled out my paperwork, they pulled blue curtains around me in an admitting bed, handed me a hospital gown and hooked me up to more Electronic Fetal Monitors, itchy elastic bands holding uncomfortable sensors to my belly. A few hot tears slid down my cheeks—as soon as the EFMs were strapped on I knew that, statistically, my chances at a natural birth were already slipping away. I looked at the various medical devices on the walls of my curtained world and felt like I was being taken hostage.

In the mean time, I tried to occupy myself with timing my contractions on my cell phone. They were already strong enough that I had to ask Clint to apply counter-pressure to my back. The serious nurse gave me a bored look over the reading glasses low on her nose and said “Your midwife is attending a birth, but she’ll try to check in on you in five minutes.” I waited in my shadowy blue curtained world for five minutes that turned into three hours. By this time I just wanted to go home. My baby seemed fine and was moving around. Her heart rate was a little high, but I didn’t blame her, so was mine. There were a few more hot, bitter tears.

I was so relieved when the midwife on call, Tracy, finally came in. My advocate was there! She made some phone calls and consulted with an OB, who sounded hopeful that I could go home and allow my labour to progress naturally with little intervention. But both Tracy and that OB were about to change shifts, and Dr. Gupta, the OB who finally came past my blue curtains, was more concerned. She felt that my amniotic fluid was severely low and that I needed to stay. While we established that I was dilated to a stretchy 3cm by then, she didn’t feel it was moving quickly enough and she gave me two options: either they could rupture my membranes (AROM) or augment my labour with oxytocin.

By this point, tears were flowing freely down my face. So many emotions were rising up. This was not what I wanted. Neither option sounded like what I wanted at all. I had done my reading. Either of these interventions meant that my chances for ending with a caesarian were going up. I felt dehumanized in the hospital environment, like a numbered bed waiting for diagnosis. I wanted to go back out in the sunshine and green trees, to go back home and at least get the hospital bag I had packed and ready a month before. But to leave the hospital didn’t really feel like an option either… a “right” maybe, but not a real option if I was concerned for the health of the sweet baby kicking around in my tummy. It was a difficult moment.

My initial thought was that AROM would be more natural, kicking in my own labour hormones instead of the super-strong synthetic oxytocin hormones with their “cascade” of interventions, so I told Tracy that was our choice. The nurses began the process of transferring me to my own labour room. Clint went to go pick up my mom and sister (they didn’t have a Canadian cell phone with them to call), and I called my doula Heidi to come meet us at the hospital. It felt good to be in a private room, but I still felt somewhat trapped. Tracy handed off my care to Kiran, a beautiful, young doctor in our midwifery group, who explained more of what was going on and recommended that I actually go with the oxytocin, since the major risk with low fluid is drops in the baby’s heart rate due to compression during contractions. Rupturing the membranes early on meant even less fluid to cushion baby and more of a roller-coaster ride through labour.

Through the unstoppable tears—I apologized to Kiran that I really couldn’t control them but I was quite rational behind them—I chose the oxytocin. She even offered to put in the IV site for me, which was the turning point in the whole frustrating affair. My decisions were made, my midwife was taking care of me even in the midst of a medical birth, and now I just needed to do what only I could do: labour. My family and Heidi were by my side. The nurse put me on a wireless EFM so I could move around without being tangled in cords. I wiped away my tears and set my face toward labour.

And I can honestly say that labouring was the best part of the whole experience. As the contractions grew stronger and stronger, I drew deeper and deeper into myself. I shut out the bleeping beeping hospital room, the sweet nurse who had to do all these things that really annoyed me, the frustrations at what had “gone wrong.” I embraced the intensity of my body’s work. Each contraction hit hard because of the oxy, but I was not afraid. I had lost control of many aspects of the experience, but no one could labour for me or interfere with my labour.

I fell into a ritual for each contraction. I closed my eyes and drew in one deep breath as I felt a contraction coming on and let that breath out in one long, slow, low “Ohhh.” Thanks to those singing lessons I took in eighth grade, I could sometimes make that one breath last through the whole contraction! It became a song and a meditation. Despite my IV pole, I also had the freedom to move. I naturally fell into a kind of swaying dance, trying to let every muscle in my body relax each time my uterus contracted. It was a beautiful, peaceful feeling even amidst the pain.

At one point, I was labouring in the shower, Heidi focusing the warm water on my aching back, when between contractions I opened my eyes and saw Clint’s face broken into an incredible smile. “You’re doing great!” he said. “You can do this.” Something in his eyes told me that we were in the presence of the holy. By some miracle, a new life was entering the world. I remembered my favorite saint, Julian of Norwich, her favorite image of Jesus—as a mother labouring on the cross to bear us into new life in God. And I felt God’s mother-arms around me, around us, holding us up, knowing fully the pain and the power of pure life. It was an incredible moment.

I was able to labour this way, with glimpses of Clint’s Chesire smile between contractions and Heidi offering the gentlest massage and sweetly breathed support, for about 6 hours—from 8pm or so until about 2am. I laboured on the birth ball with laughing gas until I lost all track of time. But around 2 it became clear that I couldn’t make it any further without an epidural. The oxy-induced contractions had become too unnaturally strong. Suddenly, each contraction felt like it would split my body in half. No meditation or relaxation could get me through.

At this point they checked—I was only dilated to 4.5 cm. I groaned when Kiran told me. I was not even halfway to the full 10cm and I couldn’t take any more.

They must have dialed down the amount of oxytocin going into me by the time the anesthesiologist arrived to give me the epidural, because I was somehow able to sit still on the edge of the bed, leaning into Clint’s strong arms, between—and even during!—contractions while she inserted the needle into my spine. But the relief came pretty quickly, and I laid back to rest. Things became a little more foggy at this point and I was pretty much confined to the bed. Around this time, they also broke my water because the EFM was slipping and they wanted to measure baby’s heart rate by direct contact on her scalp. The ultrasound had been right—there was almost no fluid. However, I wasn’t able to rest long before her heart rate started dipping hugely with each contraction. They tried an amnio-infusion to provide artificial fluid as a cushion, but it helped only for a few contractions. I had dilated to nearly 9cm in the two hours of rest, but it wasn’t quite enough to start pushing and baby was also posterior (facing up, it’s easier to birth a baby who is face down). Then her heart rate dipped low and took nearly 6 minutes to recover—it was time to start talking about a caesarian.

We made the decision to operate at 4:10am, and Lucy Kathryn was born at 4:29. In only 19 minutes they were able to prep me for surgery and safely deliver my sweet baby. Their energy and efficiency swirled around me like a surrealist dream. As they wheeled me into the bright OR, I began crying. My chest and arms were shaking with the drugs that now numbed me up to my armpits. I said to Kiran, “I’m just so excited to meet my baby!” “You are so cute,” She replied, her reassuring hand on my shoulder. As they set up the operating screen, they stretched my arms out straight from my shoulders, I suppose to keep them out of the way. But I couldn’t help thinking again of my Mother Jesus as they pierced my side to give Lucy life.

I will never forget how her cry filled that room like a miracle. It wasn’t particularly loud or sad, just alive. Within minutes Clint was holding her skin to skin, then I was able to hold her, her swaddle balancing on my chest. Her little face was so wrinkled and white. She had no eyebrows, but she was looking around eagerly with the most beautiful bright eyes. The nurse who had been with us all night let us know that my sister had to leave for her 5am bus to Seattle-Tacoma airport, so Clint wheeled Lucy out to the waiting area and Mom and Katie and Heidi got to meet her. They took a few pictures and Katie had to go. She burst into tears at the bus stop to leave her niece and goddaughter behind.

Within 30 minutes, I was in recovery and Lucy was able to cuddle skin to skin with me and to breastfeed for the first time. She knew right what to do and ate greedily. We called my dad and Clint’s parents to let them know she was here. I look back at the pictures now with awe. I’m glowing. I couldn’t move my toes at the time, but you honestly can’t tell that I didn’t have a natural birth!

In the end, things didn’t go at all like I had hoped or imagined. Every needle and tube and intervention that I didn’t want, I got anyway. But I also got a healthy baby. And I had a positive birth experience without fear, even in the midst of complications. Even though I still wonder, “what if we had tried x? what if we avoided y?” I’m still satisfied with the outcomes. I did the best I could in the circumstances: I was well educated about birthing, I chose care providers who had the same priorities as myself, I managed my fears and pain well, I felt God’s presence around us, and I made the best decisions I could in the moment. There’s not much more I could ask for!