I'm sitting here nursing my sweet, fat baby boy, who was born, but not birthed, nine months ago. I've told his birth story in bits and pieces, but I've never sat down to write it out in its entirety.
For our fifth birth, we had planned another unassisted waterbirth. I expected it would be very similar to my third and fourth births, which were very peaceful and lovely. They were fantastic births. This was to be our last birth, and I wanted it to be special and magical.
The morning of Sunday, May 16th, my contractions intensified to the level that signaled "Okay, this is it!", and went from 15 minutes apart to 8 minutes apart. My husband was getting ready to leave to teach a class, and I asked him to please stay home. This was our fifth baby, and while it could take a while, it could also be fairly quick. My previous two labors had both been about 6 hours from that point to baby-in-arms, and the baby before that had arrived after 3 hours of very intense labor - doing some quick calculations in my head told me that if my husband went to teach his class, he could potentially miss most of the labor, and even the birth. Even if the birth went longer than that, I wanted him there to take care of the children so I could just rest and let things happen. He was very reluctant to skip out on his class: "I just don't think you're really in labor," he said.
I was irritated, and explained that I was at exactly the same point when I called him to come home with the two births before that. Even though I was insistent, he remained unconvinced, but he did get someone to cover his class.
We were not entirely prepared for the baby to arrive just yet; his due date was not for another two weeks. I readied the birth supplies we had, and we called on a friend to try to locate a pump to blow up our birth tub. He was able to find one, and dropped it off that afternoon. Adam blew it up and made sure it was ready for when I might need it. I was still having contractions about every 7-8 minutes apart, and was eating and resting. During my first birth I had learned a valuable lesson about birthing hungry and exhausted, and I was determined to avoid that.
At around 8 PM that evening, twelve hours after I decided I was in labor, my contractions spaced out a bit (to about 15 minutes apart, and as much as 20 minutes) and they became more irregular and slightly less intense. I joked to my husband, "I guess you could have gone to your class, after all!" I took the time to read online the birth stories of grand-multiparas, and was reassured by the reminder that fifth and subsequent births can sometimes have healthy labors that took a while to establish well, and that an erratic prelabor can carry on over days. I would continue to rest and take care of myself, and baby would arrive in good time. I just needed to be patient with a labor that was not going to be as straightforward as expected. I could still feel the feet in front, so I knew that the baby was head down, but still posterior.
At midnight, they picked up again, and were 8 minutes apart and very regular. An hour later, they were 5 minutes apart, and an hour after that they were every 3 to 4 minutes and quite intense. I waited another hour before waking my husband to help me with the tub. He filled it with water, and I got in. I felt some relief in the water, but it wasn't as comforting and relaxing as I remembered it being with my last two births, which had both been waterbirths. I was also concerned that being in the water too long might cause a stall in labor, since it had been a bit erratic getting to that point. I switched positions in the water often, trying to find a comfortable position to zone out in. Adam topped off the tub with warm water when it started to get too chilly. Around 6 AM, I got out and sat on the couch for a while, watching TV, although I can't remember what I watched. Some old sitcom, and Adam laughed when he saw what it was.
(Laboring in the tub in the early morning hours)
I got back in the tub and out again a few times, and either Adam or I filled it with hot water to keep the temperature cozy. It was nice, but unlike my two prior waterbirths, I didn't feel the sense of complete belonging in the water. Sometime in midmorning, I went upstairs and for the next few hours I spent a great deal of time in the bed, trying to sleep between contractions, and in the bathroom. Being on the toilet felt very comfortable, so I spent a lot of time sitting there, one arm resting on the sink ledge, and the other hanging on the doorknob of the open door. In the bedroom, I tried lying on my side, kneeling with my chest on pillows, standing and leaning forward on the bed. I did lots of hands-and-knees rocking to relieve the back labor and to maybe encourage baby to roll over to an anterior position. I also tried lunges, swaying, and every other movement I could conceive of. I also gave up a few times and just laid down to sleep. Nothing felt right, and I was increasingly uncomfortable. At one point in the afternoon, I felt some small kicks (still in the front) and I realized that up until that moment, I had wondered if the baby had died. I started weeping in relief, so grateful for the signal from my baby that all was well. I was having to stay on top of negative thoughts, which began surfacing. I told myself that it really wasn't taking too long, I had just started watching the clock too soon. I had to keep telling myself that everything was fine, that sometimes it just takes longer than expected. I tried to force myself to eat some pizza, since I knew I was depleted and that was no state to birth in. It felt like sawdust in my mouth, and I could barely choke down more than a couple bites, even washing it down with a drink. The thoughts that it was taking too long, that the baby was stuck, that something was wrong, were there on a regular basis, and staying on top of them became more challenging.
Around 4 PM, I decided I was going to just squat in the bathroom and push the baby out. I had no idea how dilated I was, and had absolutely no urge to push, but I was determined to just power the baby out through sheer effort and will. I pushed and pushed, and during a break I told my husband to get the birth supplies. I had never before during a birth felt any need to have the cord clamps nearby, since we wait for the cord to stop pulsing and the placenta to be birthed before we cut the cord, and that allows several minutes to go get them after baby is born. I kept thinking, "He might need to cut the cord right away, as soon as the head is out, if the cord is wrapped around the baby's neck." I was adamant that he get the clamps and scissors, and be ready. I could swear when I pushed that I felt something moving into the canal, which only encouraged me to continue pushing out a baby with no signs of readiness. Adam said gently, "Stop pushing... you're going to hurt yourself. Just let the baby come." "But the baby is NOT coming!" I said. I felt reassured by his calm confidence, but he didn't seem to understand that the baby was simply not moving down, and that I was no closer to giving birth than I had been 12 hours before that. I insisted on purple pushing for a while; I was pushing HARD. Naturally after a few minutes of that effort, I had to accept the fact that it wasn't working, and probably had never been a good idea to begin with. I normally have some swelling during labor, but after the forced pushing I was more swollen than I had ever been; walking after that I felt like I had a rolled up towel between my legs. I went back to resting in the bed, changing positions trying to find comfort, and sitting on the toilet. I was afraid to sleep because I felt that things were slowing down, and I was afraid that sleep would stall my labor completely. I was so done, I couldn't stand the thought of that.
At about 8 PM, I realized the contractions had tapered out a bit and they were irregular again. I went downstairs and said, "I think I need to go to the hospital." Something inside me had shifted; I just could not do it any more. My husband was worried and relieved at the same time. Without letting on at all, he had been fielding calls from relatives, whose supportiveness had given way to concern as the hours ticked by and there was no progress to report.
I called my friend Kristi, and as soon as she heard my voice she said, "Do you need me to come get the kids?" I was shaky and panicky, and I told her I was going to transfer, and yes, could she please come get the kids. She said, "Before you transfer, would you like to talk to my midwife?" I said yes, and she gave me the number. I called Brenda right away, and explained the situation to her. She was very warm and calm; she said that everything I was describing sounded completely in line with a normal fifth birth and posterior presentation. She urged me to eat a sandwich, and try to get some sleep, and if I could sleep I would probably wake up refreshed and labor would pick up. She assured me that the baby would be fine, even if labor dragged on over the next couple of days.
I hung up with her, feeling very relieved, and relayed to Adam what she had said. He looked comforted and said, "Alright then." That even a long labor wouldn't harm the baby was all he needed to hear to have renewed aplomb.
I said, "I feel so much better. Let's go ahead and get ready to go in to the hospital." He did a doubletake and said, "What?" I replied that even though she made sense and I felt reassured, I absolutely couldn't do it any more. Every single contraction came with a wave of panic; my resilience was shot. The midwife called back; she had spoken with the birth center at the hospital we would be going to if we we did decide to transfer, to try to feel out what kind of reception we might expect. She said it didn't seem that we would be treated poorly, even without having had prenatal care. Adam asked again if I was sure I wanted to go in to the hospital, and while I felt sad and conflicted about giving up on our homebirth, I said yes. "It may very well be true that if I just rest and let things progress, everything will be fine. I know I'm crapping out, wimping out, but I just can't do it any more. I can't have One. More. Contraction." I was very set on the epidural at that point, and possibly a Cesarean section.
I called Kristi again, and said we were going in to the hospital. At some point I wasn't aware of, she talked to Adam and warned him that the labor and delivery staff may not be respectful of me or my wishes, and that he might have to fight for me. Having encountered the resistance of medical staff in the past, Adam knew that was true.
We explained to the children what was happening, in positive terms, and that they would be spending the night at Kristi's house. While we waited for her, I looked for pants. I remember that my skin hurt, and that pants were so horribly constricting. They were torture.Kristi arrived shortly after, and began herding my children toward the door. "Okay, let's get your shoes on," she said to them. I was leaning on the couch having a contraction, and I exclaimed, "They don't need shoes!" I was feeling very urgent. She got the carseats she needed from our van, and piled my kids in hers without their shoes, or any change of clothes.
Adam and I got into the van, and drove to the hospital. I only had my much-worn slippers on, myself. We entered through the ER, and they sent us straight up to the birth center. The nurses were all very welcoming. When I explained that we had been planning an unassisted homebirth, and that I had not had any outside prenatal care for the entire pregnancy, they didn't bat an eyelash. "Well, this is your fifth, you certainly know what you're doing!" they said.
We arrived around 9 PM. The first thing they did after they got me settled in was check my dilation; they were pretty astonished by the amount of swelling I had. I was at a very stretchy 8 cm with a bulging bag of waters; the baby was still high. They searched for the baby's heartbeat with the Doppler, and it was at about 136 or so between contractions. During contractions, the heart rate would drop very, very low. It rebounded well after the contraction passed, so they weren't particularly worried. For a while, they suggested I change positions or rest as I needed. I mostly wanted to lie on my side, and I wondered when they would offer the epidural.
They decided to use continuous external fetal monitoring after a while, and I agreed. During contractions, the baby's heart slowed to an itermittent beep... beep... .... ... beep ... ... .... beep ... ... ... ... ... beep... .... ... ..... that was disconcerting to hear. The CNM said she would like to break my waters, and I agreed. I hoped that when the waters were broken, the contractions would pick up and the baby would come soon after. She broke the waters then, and I felt a huge sense of relief. My dilation went back to about 7 cm then, since the bag of waters was no longer putting pressure against my cervix. The baby was very high still, and besides being posterior was asynclitic, so the head was not against the cervix properly. The CNM asked if I felt like pushing at all, and said to give a few pushes to see if the baby would come down against the cervix when I did. When I pushed, the head did come down, and the cervix would open a bit under the pressure, but when I stopped pushing the baby went back up and the dilation went back to 7. Over and over, everyone affirmed my knowledge, my experience, and my intuition. They were very respectful, and I was very pleased by the level of informed consent/refusal that they offered. Sometimes it sounded like they had learned some "useful catchphrases" like It's your body and your birth that they repeated with a little more frequency than sounded really genuine to my skeptical ears, but it was so much better than what I had anticipated, I couldn't complain. I also felt that they a vaginal birth was their priority, and even through the contractions I appreciated that.
The CNM and nurses who were my caregivers were very reassuring about the heart rate, but they called in the OB to evaluate it. She examined me and suggested an internal monitor so we could have an accurate measure of the baby's heart rate. My husband started to stand up to tell her that I would not want that, since he knew how opposed I am to needless interventions. I held my hand out to him and said that it was something I wanted, that I wanted the information it could give and it was worth the risks. They inserted the internal monitor, and also a catheter to measure the intensity of my contractions.
The internal monitor showed that the baby's heart rate was dropping to about 20 beats per minute during every contraction, and the catheter revealed that my contractions were not strong, even though they were painful. Two hours after AROM, the baby was still high (station was +2) and there had been no increase in dilation. The OB said that we might want to consider augmentation with Pitocin, to get the contractions stronger and closer together. I felt very panicky at the thought of Pitocin, and I said that it didn't seem to me that it would be a good idea to increase the contractions if the baby's heart rate was dipping so low during them. She said that the hope would be that after starting Pit, even a small dose, things would pick up and the baby would be born quickly, before it had a chance to get distressed. While I wanted it to be over fast, the idea of Pit made me want to run away; I couldn't stand the thought. It seemed like a horrible, horrible idea.
At one point, we were alone in the room, and I turned to Adam and said, "They are going to make me ask for the C-section!" Because I was so stressed and exhausted by the contractions, I asked for something for the pain. I had was hoping for an epidural, because I just didn't want to feel any more contractions, but they offered to give me some pain medicine in my IV. I accepted, and hoped for some rest; it took some of the frantic agitation away but I didn't sleep.
I realized how different this whole experience was from anything I had ever had, and how many different choices I was making than I ever would have imagined. I would never have expected to agree to any interventions, let alone all the ones that I did. I told Adam, "This whole thing is going to make me such a better doula -- I'll be so much better able to understand and support moms in their choices now!"
After a while, since I had not made any "progress" in labor since I got to the hospital, the OB brought up the idea of Pitocin again; again, I felt very strongly against the idea but would have probably acquiesced. They were very committed to me having a vaginal birth, and I got the feeling that the Pit was a last-ditch effort toward that end. A few minutes later, she came back in the room, and sat down at the end of the bed. She looked very serious, and said gently, "I don't think Pitocin is a good option for us. Even though the baby is rebounding well between contractions, I'm afraid it might stress him too much. I'm going to recommend a C-section." The relief that washed over me was amazing. I still felt sadness at not having a sweet, lovely homebirth, but the strongest feeling I had was one of "Finally!"
Once I gave my consent for the Cesarean section, they came in to give me a catheter. Before they inserted it, the CNM said, "Do you want to try pushing a little bit?" I pushed and pushed, and she tried some manual dilation as well; I could get the baby's head against my cervix during the push, but it floated right back up. "If there's a chance to do it this way, we should try," she said. She seemed very disappointed to proceed with prepping me for surgery.
When they were about to do the catheter, I said, "I need to pee, can I go do that before you do the cath?" They said, there's no reason for that, this will empty your bladder. They started inserting the catheter, but all the swelling made it quite difficult. It was horrifically painful; I was writhing and screeching involuntarily, and urine was gushing out of me like a geyser. I grabbed my husband and begged him, "Tell them I'm not usually a big baby! Tell them I'm not normally like this!" He said, "I'm not going to say that!" and the nurse said, "Believe me, no one is thinking that." The pain was very intense, and it continued to burn once they were finished and were taping it to my leg. Even the tape hurt, my skin felt incredibly tender.
We began on our way to the OR. It felt so surreal, watching the hospital ceiling rolling overhead, the brightness of the lights. It seemed like a lifetime ago that I was in a tub in my dining room, and the finality of the moment, the fact that I was actually headed in for a Cesarean section, something I never thought I would have, gave that trip a dreamlike quality.
They stopped Adam from coming in until after I was anesthetized. He said that he was trying to get to me to give me a kiss before they separated us, and the OB leaped in front of him with her arms out, telling him, "No, no, you have to wait!" He didn't care much for her, to say the least.
In the OR, the anesthesiologist introduced himself and explained everything he was going to do. He was a warm, funny man, and he said, "I know that a C-section is the farthest thing from what you had planned; I'll try to make it as nice as I can. I know this isn't what you wanted at all." He explained every step of the way what to expect and checked in with me frequently. The epidural was quite uncomfortable going in; and painful when it hit a nerve. Once it started to take effect, my legs felt like they were under a lead blanket. At that moment, I couldn't imagine choosing an epidural over an unmedicated birth. Not being able to feel anything was a relief to me (especially since I couldn't feel that catheter anymore!) but it divorced me from my body and the experience. "Your arms might feel very jerky and shaky; just let them go," the anesthesiologist advised. "If you try to hold them still, that will just make you uncomfortable." Adam was allowed to join me once I was fully anesthetized and could not feel pain from the chest down. I was not strapped down or shaved.
He stood at my head, and because he was standing he was able to peer over the blue curtain that blocked my view. He watched from the first incision. "Oh, a gusher!" he joked. I believe the OB gave him a bit of a look at that, but I was really in my own world at that point. The anesthesiologist chatted with me amicably and I remember really appreciating his bedside manner. My arms flopped and jerked, and my teeth chattered uncontrollably. There was a lot of intense tugging and pulling beyond the blue screen; the anesthesiologist was right there saying, "You're going to feel some very strong pulling right now, it will probably feel like they've climbed right up on the table with you." At one point I realized if I craned just a little, I probably could watch what was going on in the reflective surface of one of the lights... I decided against it. I drifted in and out of consciousness. I was overwhelmingly sleepy.
I heard a short, newborn cry. I felt insane relief, my husband put his head next to mine and I cried. "I'm so glad we came in to the hospital," I said. He nodded against my hair.
What I was unaware of was that as soon as they had cut the incision in my uterus and pulled out the baby's head (which was quite easy, because it was not lodged in the pelvis at all) a constrictive band that had formed around my uterus clamped down around the baby's neck. (A Bandl's ring.) He saw them wrestling with my uterus to free the baby; he said it was clear that something was wrong. The intense silence and serious expressions they had as they worked to get the baby out indicated clearly that what was happening was not right. The OB looked at him, and he took the warning in her gaze and dropped down beside me. At that moment, he was terrified that our baby was in danger, and all he could do was listen to me weep with relief, blissfully ignorant of the scene that was happening on the other side of the curtain. I found out later that the OB did a T-cut, cutting up through the band, to finally release the baby. What should have taken about 30 seconds took about 6 minutes.The cord had also been wrapped around his neck; later on, when I asked how tight it was (trying to determine if it was something that mattered in the outcome of the birth, or just a regular old cord around the neck) and the OB and her assistant said in perfect unison, "Tight enough!" which of course was no answer at all.
There were no more cries, and I told my husband who seemed worried, "C-section babies often have a slow start breathing, it will be okay." They told us, "It's a boy!" and they took him immediately to the table, well out of my view. We named him Kai Helio, and he was 7 pounds, 2 ounces. They showed him to me, all wrapped up and beautiful, and the pediatrician said that they were going to take him to the warmer. "The warmest place for a newborn is on his mother," I said, but my protests were feeble, and he didn't listen at all. He was the only person who completely disregarded me in the entire experience.
"Go with the baby!" I urged Adam. He didn't seem to want to leave my side while I was being stitched up, but he also wanted to be with the baby. He left then, and the anesthesiologist made skillful small talk with me while I was stitched up. He and his wife had greatly enjoyed the ice wine when they visited Niagra; I'll always remember that. The man could carry on a cheerful, seamless conversation about any topic. I could barely keep my eyes open; I was exhausted.
I was finally taken to my room. The nurse came in and explained that the baby had been having some trouble breathing, so they had him on oxygen. I told them that I was breastfeeding and I didn't want him to have anything to eat or any nipples, and they were very adamant that he would not. Adam came back to stay with me; I don't remember much about it. He was leaving to go home; our apartment complex was having their annual inspections that day, and because of my laboring over the last few days, our apartment wasn't at all presentable. We'd arranged to hire a housekeeper to get it ready, but Adam had to go home to clean up and meet with her; he didn't want to but I was too worried about it. (The inspection never occurred. If we'd known that, he would have just stayed with me! I haven't felt the same about our apartment complex since.) He went to say good-bye to the baby, and then came in, beaming from ear to ear and pushing a basinette. The baby was off the oxygen, and they brought him to me to nurse. I got to hold my sweet boy for the first time. He was so amazing and precious, with lots of dark hair. He started nursing well. After he was done, the nurses took him back for more monitoring since they said he was still having some problems breathing. They brought him back about an hour later, and he was in my room with me from then on. I was given the option to allow or refuse the Vitamin K shot, etc.
Overall, the whole experience felt very positive. I was so blessed with the nurses and doctors I encountered (except the pediatrician) and for a hospital labor and Cesarean birth it was very affirming. They were beautifully and effectively supportive of breastfeeding, and did not care if I slept with him in my hospital bed.
|(Adam meets Kai for the first time) |
I didn't have any doubts about the necessity of the Cesarean; since then I've asked myself lots of questions and tried to figure out if there was a point that I could have stopped the path to the surgery. Maybe there was, maybe there wasn't. I still haven't figured that out to my satisfaction, and I know that there's a good chance I never will be able to know with any certainty if it was or wasn't preventable. Certainly there are grand-multiparas who successfully birth posterior, asynclitic babies with nuchal cords. Does that mean if I'd just stuck it out, I could have? Or was it more likely that I would rupture due to the Bandl's ring first? I did grieve the birth I had wanted; despite all that labor, I never got that amazing, powerful, indescribable feeling of pushing my last baby into the world. I felt a little robbed of that; I kept thinking, "But it was my LAST birth! It wasn't supposed to be like that." Because of my reasonably positive experience with the transfer and surgical birth, I felt relieved and rescued... quite a different sensation than the feeling that comes with an unhindered, empowered homebirth. I may always feel wistful for that feeling, a feeling I had planned to savor with the bittersweet awareness that it would be the last time I would ever experience birth.
I do know that this little boy is wonderful, and I wouldn't care if robots had to drill through my abdomen to wrench him out -- he would be worth it.
(Kai Helio, growing up and all smiles)