Friday, January 10, 2014

My Second Chance Birth

Today is my last day of maternity leave, so it's time to kick this story out into the blogosphere. I'd like to start by celebrating that I got my home birth.

Leo Scott, born November 25, 2013

Home birth doesn’t just fall in your lap. I drove an hour each way for my prenatal appointments, paid out-of-pocket for a birth assistant and medical supplies, and had to find a new pediatric care provider when my toddler’s provider said he wouldn’t see my baby if he was born at home. When I was 38 weeks pregnant, an insurance representative incorrectly told me that they do not cover home birth. A week after birth, I got stuck in another insurance snafu that made getting my baby’s newborn metabolic screening nearly impossible.

So why bother with the road less traveled when things could have been so much easier?

I had a vision of how birth could be. I’ve seen it in documentaries and read about it in Ina May Gaskin’s books. I sampled just a taste of it during my first birth, which rapidly turned into a freight train of runaway contractions, vomiting, dehydration, and Stadol. Everyone told me I did a great job with my first labor and that anxiety just got the better of me, but I wasn’t satisfied. I didn’t know if I had the capability of navigating birth and introducing my baby to life with the ease and grace with which I heard was possible—and I needed to find out. So, without further ado, here’s how my second shot at labor went down.

My first few contractions started the minute my moms walked in the door after their 12 hour drive from Florida. We were all hoping they would arrive in time for the birth and had no idea how close they would cut it. At first I wasn’t sure if the contractions were real. I braced myself on the kitchen counter for a clear, deep breath, then rested on the sofa feeling my way through those first squeezes. Two hours later, I was on my hands and knees in the middle of my toddler’s bedtime routine.

I called the midwife and birth assistant to talk my way through what was happening. We decided to call it early labor, and my team started their trek toward my house just in case things progressed quickly. Meanwhile, my midwife encouraged me to take a warm bath and then try to get some sleep.

At midnight the midwife was on my front porch, and the birth assistant was close behind. After an initial exam, the two of them decided to camp out on the downstairs sofas until I showed signs of active labor.

Time blurred once everyone in the house was sleeping. It made sense to let everyone get as much rest as possible so that they’d have the stamina to help me when things got intense. But there I was, awake and aching for someone’s touch. I choked down the growing knot in my throat and asked my husband for help. He broke open the essential oils and commenced rubbing my feet. Tears streamed down my face; I wasn’t alone anymore.

Over the next hour I dozed between contractions just as I had while on Stadol during my first birth. It was my most restful hour of the night even though contractions sped up to every 5 minutes. At 4am, my husband woke the birth team, and they came upstairs to start their care.

One of my birth plan requests was to not tell me how dilated I was or what station the baby was unless I specifically asked. Numbers got in my way last time and triggered unnecessary anxiety. But just this once, I asked for a report. I was coasting through labor and wanted confirmation that something was happening.

“Six centimeters, 2+ station,” said the midwife.

It has to get harder than this, I thought. Last time I walked into the birth center at 4 centimeters, -2 station and begging for drugs. My midwife said that because my water hadn’t broken like at the beginning of my first labor, I had a cushion between me and my baby’s head. I was proud of myself for coping so well this time around, but even more so, I felt unforeseen relief in the knowledge that my inability to cope last time was not my fault. I didn’t have a weak character or resolve. I didn’t have an unusual problem with anxiety. I just got dealt a bad hand.
Active labor was in full swing, and because I had tested GBS positive this pregnancy, I received IV antibiotics to minimize the baby’s risk of exposure. The birth assistant hung the IV bag from the ceiling fan, and after 15 minutes, I was free to move around. The contractions again sped up, and I headed for the tub.

“Do you prefer we stay in here with you, or do you want us out of your way?” asked my midwife.

The birth assistant, midwife, and my husband stood looking to me for instructions. The knot in my throat swelled again.

“I don’t know,” I said. Then the tears fell.

“Aw, get her moms,” said the midwife. That’s exactly what I needed—the silent presence of women who know me inside and out and understand exactly how to support me with touch, tears, and well-timed words of encouragement.

In just a couple minutes, my moms came up from the guest bedroom. What followed was one of the most beautiful parts of my labor. I couldn’t have picked better music for my labor playlist. My moms complimented me on how peaceful and relaxed I seemed. I drifted back and forth between deep breaths with eyes closed to eyes wide open and cracking jokes.

At 7:30am, my toddler woke up. The adults took turns watching him and ushering him in and out of the bathroom when he wanted to see what was going on.

Things started getting intense over the next hour. Waves of nausea hit me between contractions and my midwife thought for sure that the last bit of my cervix was dilating. I decided to move to the bed for a rest, but it wasn’t long before my midwife strongly encouraged me to get upright.

“I really think your water needs to break before this baby will come out,” she said. “Let’s get up and do some sideways lunges on the stairs.”

So after being up all night and headed into my 13th hour of labor, I got up. I gave my midwife the evil eye and headed for the stairs.

Every time a contraction hit, I’d stop on the stairs and squat. I kept going. I persevered. But right before 9am, I plopped down at the top of the stairs and despaired.

“I have to get this baby out,” I said.

I meant it, and my midwife could tell. I started seriously entertaining the possibility that I might need to go to the hospital for an epidural so that I could rest and try pushing the baby out later.

“Well, here’s an option,” said the midwife. “We can keep letting things progress naturally and not intervene, or we could break your water and see if that speeds things up.”

“Yes,” I said. "Let's do that."

“Now, you have to realize that things will probably get even more intense once we do this,” she warned.

“Let’s do it,” I said.

She did it, and she was right. She didn’t tell me until after the birth, but when she went to break my water, she discovered that I was still only 6 centimeters dilated—the same as the first time she had checked me 5 hours earlier. Breaking my water immediately opened me to 7 centimeters and ushered me into transition.

Just as my labor got every bit as intense as my first had been, my midwife made me get up. Again. I squatted beside my bed with every contraction and in less than 10 minutes I headed back to the tub.

The warm water helped me get a grip. When the temperature dropped, my mom would turn on the hot water and swirl it with her hand like warm ribbons wrapping around my torso. I felt the urge to push, but with every push it felt like there was no way out for my baby. I’d go with the urge and then stop cold against what seemed like a closed door pushing all the pressure back inside me with its unyielding tension.

I switched from deep breaths to low moans--the embarrassing ones that I never thought would come out of me until I experienced my first labor. My midwife coached my breath, position, and sounds. She asked me questions about what I was feeling. Finally, she asked me to reach down and tell her if I could feel my baby’s head. I could, but I still felt no relief or progression.

“I see hair!” she said. Still no solace.

Then out of nowhere, out came my baby’s head.

“Okay, Melissa, I need you to stand up,” said my midwife. She had warned me about this possibility earlier in the night. Babies can be born in the water, but if the head starts bobbing in and out of the water, it’s no longer safe.

I hiked my leg up on the side of the tub and squatted one more time. My mom says the midwife literally caught my baby, but it felt like she pulled him out as he broke the rest of his way into the world.

“Thank god!” I half sighed and half roared. I peeked down and saw my baby’s bluish skin. “Is he okay?”

“He’s fine,” said the midwife. But I heard no cry.

“Is he okay?” I asked, this time with more urgency. My baby answered this time with his beautiful cry.

My midwife handed me my baby and I walked back to bed with my prize. My husband and toddler joined me on the bed, both with equally wide eyes. My toddler wasn’t in the bathroom for the birth, but I had prepped him with my Mamamor birth and breastfeeding doll, so he wasn’t fazed by the cord or the placenta that followed.

“Baby brother!” he yelled with a huge smile stuck on his face.

The third stage of labor, breastfeeding, newborn exam, and standard postpartum care followed. Everyone told me I could sit up or do whatever I felt I needed to do. But all I wanted to do was lie horizontal, admire my baby, and revel in how pain-free and at rest I felt.

I did it. I birthed my baby.

If I could go back and do it over again, I wouldn’t change a thing. Nature dealt me a good hand this time around, and I knew how to handle it—one contraction, one breath, and one minute at a time. I got lucky, yes, but I didn’t just win the labor lottery. Birthing at home helped me avoid unnecessary tension by nixing the car ride to my birth site. It also allowed me to visualize the birth ahead of time in the very room it was likely to take place in. I practiced deep breathing in the tub and guided meditation in my bed. My nightstand housed a copy of CNM Nancy Bardacke’s Mindful Birthing.

And it wasn’t just about my experience. I believe what I did was best for my baby, too. I had gestational diabetes that was well controlled through diet and exercise. Despite our best efforts, nobody knew how big my baby would be. A 36 week ultrasound estimated 6 pounds, 11 ounces. At 38 weeks the midwife guessed 7 ½ pounds. On his birthday at 39 ½ weeks, it took me an hour to push out all 9 pounds, 12 ounces of him. If I had run into trouble getting him out, we had an emergency hospital transfer plan ready to go. It wouldn’t have been fun, but we all knew what to do just in case. If I had started in a hospital, my care team probably would have freaked out about me staying at 6 centimeters for 5 hours. If we got past that, I probably would have asked for an epidural, which probably would have further extended the pushing phase, which would have raised our risk for a cesarean section. Instead, we had a peaceful birth followed by plenty of time to establish breastfeeding before proceeding to eye drops, vitamin K, and blood sugar testing on the bed right by my side.

Another mother-baby combo could have faced the same situation and decided on a completely different route. In the end, I think birth setting is an extremely personal decision with no black and white answers. There are risks and benefits to every birth setting, and every woman deserves the freedom and authority to weigh them for herself and her baby.

I’m so thankful for my birth team, my family, and all the friends and health care providers I consulted along the way who lent me their best advice and knowledge. I ended up with a deeply satisfying birth experience that taught me how to voice my needs, fight for what I want, and confidently face each moment one breath at a time.
“So birth like a lion. Roar your baby out. Thrash and burn and yell and squeeze tighter….let the train barrel through you, hold on tightly, jump out of your body and right back in again. Deep down sounds—low in your belly. Growl. Yes. Birth is like this.”


Eileen said...

Melissa, it was a honor to read your beautiful birth story. Thanks for sharing it.


Tina said...

Thanks so much for sharing Melissa. Beautifully written deeply insightful and inspirational. You are amazing.