water birth

Birth Story: "Intense. But incredible."

birth story_4 Baby Hamilton's birth story, as told by mama

I feel very blessed to have had a wonderful pregnancy, birth, and start to life together as a new family of three--and have to thank Health Foundations for providing the support to make it happen. When I became pregnant, I thought how and where I was going to give birth would be a no-brainer--I assumed I would do what all of my friends did: a hospital birth, with my OB, and definitely an epidural (you’d be crazy not to, right?!).

My first trimester was going so smoothly that I became a bit paranoid that I wasn't really pregnant. So Fran and I kept our pregnancy a secret from everyone until we made it to the second trimester. During that first trimester it felt like a mini honeymoon with Fran because we found ourselves staying in to avoid the questions around why I wasn’t drinking, etc. One night we searched Netflix for anything “baby” and came across “The Business of Being Born.” This documentary opened our eyes to a whole new concept around birth, and spoke to me in a way that really excited me. Fran and I had spent the prior 2.5 years completely changing our approach to health. Essentially we committed to putting health first, starting with our approach to fitness (we joined a Crossfit gym) and then diet (we did a lot of research around the pitfalls of the “standard American diet” and starting to cut out grains and sugars that were inflaming our system and keeping our bodies from burning fat for energy).

We had such a positive experience with this “alternative” approach to health, that I found myself very receptive to an “alternative” approach to childbirth. I have never had a need to go to a hospital before in my life, so I really started to wonder why I should need to be in a hospital now, with all these potential intervention measures, when I was the healthiest I’d ever been in my life and knew that women have been delivering babies naturally for thousands of years? After watching that documentary and a few others, we started doing a lot of reading and research, we toured birth centers and hospitals, and spoke to midwives and my OB about our options. After a lot of debate and consideration, we followed our gut instinct and decided to transfer to Health Foundations when I was 20 weeks in to my pregnancy. The remaining fears I had around being out of the hospital quickly went away as I had my prenatal appointments with the midwives and started taking the child birth education classes.

Okay-- now on to my birth story!

When I was 34 weeks along, I got this strong feeling that my baby was going to come early. I don’t know what it was, but I was convinced. So imagine my disappointed when my “due date” came and went, and no sign of baby! I chalked it up to my first lesson in motherhood--I’m on someone else’s schedule now. He calls the shots! So time to temper my expectations and go with the flow. Easier said than done, especially when my biggest fear was getting to 42 weeks and having to go to a hospital to deliver the baby.

When I went in for my 40 week appointment Monica checked me, and she said I was still very posterior. So I spent the week going on lots of walks, got adjusted a couple times, and tried accupuncture. At my 41 week appointment (Tues), Monica swept my membranes, which made me pretty crampy for the next day or so. Through the baby stress test at 41 weeks the baby checked out as healthy and the machine showed that I was having contractions--that was a surprise because I wasn't feeling them! Encouraging, my body was working away! I also went in for an ultrasound to check on amniotic fluid--all looked good.

On Friday of that week I had my next appt with Monica, and she thought maybe baby's head was a bit tilted, preventing him from engaging my cervix. So she showed me how to do inversions at home to try to lift him up and off, and then go for walks to get him moving down. Along with that I did more acupuncture, took more walks. No contractions. Went in on Sunday (41 weeks and 5 days) and had the catheter put in and went for a walk. To our surprise, it fell out after 2 hours! I thought maybe I had done something wrong, because it came out but labor didn't start. Amy had me come back in that evening to get checked and get the castor oil+herbs -- which I was to take the next morning if I wasn't in labor. She said my cervix was in a good spot, but didn't share with me how dilated it was (we found out the next day that I was 4 cm at that point! I'm glad she didn't tell me -- would have messed with my head I’m sure).

Cramps started to get intense around 6pm on Sunday, after that appointment. We went for a walk and went grocery shopping. I took a bath at 8pm to ease the cramping, and to get ready to go to bed early to try to get some good rest. I was in bed at 9pm, and contractions started then. From 9pm-1am I was able to rest/sleep between the contractions (8-10 min apart). My back was really feeling it, so I put on a hot pack which really helped. Fran was great at telling me to relax, just as we practiced in class.

At 1am I couldn't lay anymore -- contractions were getting more intense, and about 6-8 minutes apart. I tried different positions but all I could handle was standing and leaning against the wall, and then between contractions I found myself pacing the bedroom (with all the adrenaline, I had a hard time relaxing). I had a few unpleasant trips to the bathroom, where I threw up everything in my system. We called the midwife page at 2am, when contractions were about 5-6 min apart. Amy was excited for me that I was going to be able to have this baby without castor oil (I'm pretty sure having that bottle stare me in the face was what started labor) and she listened to me breathe through a contraction. I could still talk through contractions and wasn't yet vocalizing, so she told me to keep it up and said that next time I call I won't be able to talk as much.

At that point we called our doula, Sarah, and she came over. She had me take a hot shower, which felt great on my back. And then encouraged me to try laboring on my hands and knees, and start to really focus on resting between contractions (head down on a pillow) and pay less attention to the contraction. This helped me get some much needed rest. Contractions were getting more intense, and I had to fight the urge to pace and lean against the wall like before. Sarah left the room to let me and Fran work through contractions together, and she listened from outside the door. My contractions weren’t following a consistent pattern so after a while in that position, Sarah suggested I pull one leg forward (like a deep runners lunge) and do juicy hip circles (Sarah is also a yoga instructor at Blooma, so she was using cues that she uses in the classes I would go to--which was nice and familiar). I thought she was nuts, because I thought that would be too much, too hard. Between contractions I told her that I was never going to think of those juicy hip circles the same way again! :)

But I gave it a whirl -- for 2 contractions on each side. Well that seemed to adjust baby’s position, because I definitely started to feel something new, which I later confirmed was the urge to push! I just went with it, thinking I was still more than 3 minutes apart on contractions (I had mentally prepared for a very long labor)--and I didn't really wrap my head around the fact that I was already through transition. I guess those juicy hip circles in the runners lunge helped me get through that. But apparently my vocalization changed and based on how I sounded, my doula suggested we make the move to the birth center. This was around 4:30am. Sarah got in touch with Amy, who heard me in the background and said “Oh, yep, I’ll be right there!”. We jumped in the car and the car ride was as promised -- hard. Luckily there was no traffic and Fran drove very fast!

We beat the birth team to Health Foundations, so I had a contraction or two on the ramp outside the door- -likely waked some neighbors (Sarah found my flip flops in the parking lot, I labored myself right out of my shoes!). Rachel got there first, and we got in the room and had a couple more contractions. I told her I felt my body pushing, so she checked me, and indeed I was 9 cm dilated- with just a lip remaining! She asked if I wanted a water birth, and I said I was open to it (I wanted to let my labor decide what would feel best when the time came). But I really wanted to labor in the tub for some relief. So she started filling the tub right away--though it felt like an eternity before it was full. While I waited, I labored on the bed on all fours, and put my head down on a pillow to rest in between. Fran got emotional at this point, as he was so relieved that we were at Health Foundations and in good hands--everything got so intense so fast! At one point I looked up between contractions and said “tub time?”... I was thinking, let’s do this! I wanted to get in there and be able to move forward with pushing.

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The tub was full, I got in, and the pushing urge was really there -- Rachel said I could, but slowly like I had been outside the tub. All in all, I pushed for about an hour (the total time I was in labor at the birth center!) -- and our baby arrived! I was on my hands and knees, so Rachel said that once he was born she would push him through my legs and he would swim up to me so I could catch him and bring him out of the water. It was completely amazing. He came swimming through with his eyes wide open--such an incredible feeling to be able to grab him and pull him on to me.

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The birth team was awesome --I was so impressed with all of them. Fran was a champ, definitely benefited from the child birth classes to help prepare. It was tough for him to see me laboring. I am SO glad we had a doula--Sarah was amazing, and really helped at home (where the majority of labor ended up happening). I was surprised that during labor I never questioned my decision to do a natural labor. I was expecting to have doubts and to have to mentally push those thoughts out, but they never came. Also I had been nervous about my umbilical cord being around baby’s neck (I had been told that this is pretty common, but it still freaked me out)--mine ended up being wrapped around his neck once, but it didn’t harm him at all and Rachel was able to easily unwrap it.

In total I'd say I was in labor for 12 hours (including pre-labor)-- 6 of which was active labor+pushing. The birth team applauded my ability to control the pushing, and take it slow. I didn't need any stitches, and both me and baby checked out as healthy and good to go. I will share that when the nurses had me get up for the first time to use the bathroom (after about 3 hours of laying and bonding with baby), I made it to the bathroom but passed out once I got there -- I think at the sight of blood (first time I really saw any... and I have a weak stomach). The nurses took good care of me, got me lots of fluids, and back in bed without any issues.

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It was truly an amazing experience. Intense. But incredible. And everyone who has checked on our baby's health have remarked on how awake, aware, calm, strong, and healthy he is -- which was our goal in having a natural birth, and I think only made even better by going with a water birth. And my recovery was smooth and quick, I was excited I didn't need to have any stitches (even after delivering a 9 lb, 3.5 oz. baby with a 15 cm head -- which apparently is in the 99.8th%!).

Special thanks to….

Health Foundations -- for providing personal attention and care throughout my pregnancy, and an unforgettable birth experience that helped our family get started in this new life together in a healthy, beautiful, and very special way.

My Husband, Fran -- for being fully committed to being my partner through this journey, for being such a strong supporter, and a beautiful father.

My doula, Sarah Auna -- for being a strong, calm, beautiful presence and providing support through this amazing process to both me and Fran.

Crossfit St. Paul -- for helping me to put health as a top priority, and to learn that my body is stronger and more capable than my head likes to think it is and that I can push through and achieve great things.

Body Workers, Amber (chiropractor) and Adrienne (massage) -- for helping me to feel amazing throughout my pregnancy, even at 41 weeks pregnant my body felt great! You helped me truly believe that my body was made to do this and it was all very achievable--and perhaps my swift labor was possible because my body was all good to go!

Blooma -- for being a weekly reminder throughout my pregnancy that my body is completely capable of birthing this baby, and for making the journey towards motherhood a special and sacred time. And for introducing me to my amazing doula, Sarah.

My Parents -- for raising me to be an intellectually curious, confident woman who feels empowered to make informed decisions

More Evidence About Water Birth 

Amanda5 This week Evidence Based Birth released a statement of findings on the safety data available about water birth.  As you may recall, we blogged about water birth earlier this year, shortly after the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatricians (AAP) released a joint statement warning about the possible risks of water birth.  This warning resulted in some Twin Cities area hospitals stopping their practice of water births.  Since then, many hospitals have reinstated their practice of water birth in light of overwhelming evidence that water birth is a safe option for many women.

Health Foundations did not alter their water birth practices as a result of this statement, as the evidence was not there to support any such change.  We were honored to serve many women in the Twin Cities who wished to have the option of water birth and chose to change providers to allow for this option.

Evidence Based Birth’s (EBB) recent thorough account of the evidence available on water birth echoes and extends the case for water birth set forth by the American Association of Birth Centers (AABC) and The American College of Nurse Midwives (ACNM) back in April. This EBB article focuses primarily on the safety information available for birth (that is, actual delivery) in water, as the safety of water immersion during labor has already been well established.

Kinds of Research on Water Birth

Discussed in this article are the types of studies that have been used to gather information about the safety of water birth, including but not limited to:

  • Qualitative descriptions of water birth
  • Retrospective surveys
  • Small randomized trials
  • High quality prospective studies
  • Case control studies
  • Case reports

Each of these kinds of studies has their benefits and drawbacks and varies in the quality and reliability of the information they produce. For example, case reports are considered the lowest level of research evidence available.  They only discuss a single event, which can potentially give us information about rare occurrences but cannot give us any reliable information about the overall safety and risks associated with water birth.  The ACOG/AAP statement issued earlier this year was based primarily on this kind of evidence, while it ignored other, higher quality forms of evidence available.  The EBB article also asserts that this statement relied on outdated literature review and made several significant errors of fact.

While the evidence presented in the EEB article is far too detailed (which is a good thing!) to cover in this blog, we wanted to share this resource as a great place for our clients to learn more about water birth safety research currently available.  We feel this is a prudent and thorough analysis that allows women and their families to gather the information they need to make an informed decision about water birth.

As a helpful high-level guide, available high-quality research is presented on the following topics:

 Effects of water birth on mothers:

  • Normal vaginal birth
  • Episiotomy rates
  • Perineal tear and trauma rates
  • Need for pain relief and pain scores
  • Length of labor, by stages
  • Postpartum blood loss
  • Birth positioning
  • Hands-off delivery
  • Maternal satisfaction with water birth
  • Pelvic floor function

Effects of water birth on infants

  • Perinatal mortality
  • APGAR scores
  • Respiratory complications
  • Birth injuries
  • NICU or Special Care Nursery admission
  • Umbilical cord pH
  • Shoulder dystocia
  • Newborn infections
  • Group B Strep
  • Newborn microbiome
  • Umbilical cord tears
  • Newborn resuscitation

The article goes on to cover frequently asked questions about water birth, such as:

  • “Why do women get out of the tub in labor?”
  • “What evidence is available about VBAC water birth?”
  • “What are the contraindications for water birth?”
  • “Why do some women report choosing or enjoying water birth?”
  • ‘What rare adverse events have been reported?”

The bottom line

In this article, EBB includes a section about what all this detailed information means for women as they consider this choice in pregnancy.

While new research continues to improve our understanding of water birth safety, the evidence suggests that low risk women experience a lower episiotomy rate, have higher rates of intact perineum, and use less medicine for pain relief when they choose water birth.  While the benefits to newborns are less clear, so far the evidence shows that fewer or equal rates of NICU admission are seen in babies born in water compared to on land.

This research review repeats the sentiment made in the 2014 AABC and ACNM statements that “water birth is a reasonable option for low-risk women during childbirth, provided that they understand the potential benefits and risks.”  The review further states that universal bans on water birth are not evidence based.

 

We encourage you to read this article on water birth and to ask us questions about this birth option during your prenatal visits.  It is supremely important that our families have the best evidence available to make informed and empowered decisions about their pregnancies, births and postpartum.

 

 

 

 

Water Birth

maiabirth_0027Health Foundations Birth Center ~ Water Birth Delivery

With the recent release of an opinion statement on immersion in water during labor and delivery (water birth) by the American Congress of Obstetricians and Gynecologist (ACOG) and the closure of water birth programs at several Twin Cities hospitals, we wanted to explore this issue in greater detail.

The use of water during labor and birth, known as hydrotherapy, has been growing ever more popular in the United States both inside and outside of the hospital setting.  We offer the option of water birth at Health Foundations Birth Center because the best available evidence demonstrates that hydrotherapy offers physiological and psychological benefits in labor and birth. 

What the experts say

According to The American College of Nurse Midwives, “labor and birth in water can be safely offered to women with uncomplicated pregnancies and should be made available by qualified maternity care providers. Labor and birth in water may be particularly useful for women who prefer physiological childbirth and wish to avoid use of pharmacological pain relief methods.”

They further state: “Warm water immersion hydrotherapy during labor provides comfort, supports relaxation, and is a safe and effective non-pharmacologic pain relief strategy that promotes physiologic childbirth.”

The American Association of Birth Centers posits that, “water birth, with careful selection criteria and experienced providers, does not negatively affect mothers or newborns.”

Prevalence of Water Birth

Overall, approximately 6% of women in the United States experience the pain relieving benefit of hydrotherapy during labor and/or birth.  This rate is higher among midwifery and midwife-led collaborative practices.  Among midwives, water birth rates are between 15 and 64% during labor and 9 to 31% during birth.

Evidence on hydrotherapy during the first stage of labor

The first stage of labor includes early labor, active labor, and the transition into pushing and involves the thinning and full dilation of the cervix, among other things. 

Evidence for the safety and effectiveness of laboring in water during this first phase are well established.

Pain relief is the most clearly established benefit of laboring in water.  Evidence also suggests the possibility that first stage hydrotherapy can also:

  • Hasten the process of cervical dilation/shorten the duration of this stage of labor
  • Resolve labor dystocia (difficult labor or abnormally slow labor progress)
  • Increase postpartum maternal satisfaction with childbirth

There is no evidence of a positive or negative correlation between hydrotherapy during this stage and any of the following:

For mom~

  • maternal infection during or after labor and delivery
  • the length of second or third stage labor
  • type of delivery
  • perineal laceration (incidence or severity)
  • postpartum blood loss
  • rate of hemorrhage
  • postpartum depression

For baby~

  • abnormal fetal heart rate patterns
  • meconium stained amniotic fluid
  • umbilical cord blood pH values
  • newborn Apgar scores
  • infections
  • admissions to special care nurseries
  • or rate of breastfeeding at 6 weeks postpartum

Evidence on hydrotherapy during the second & third stages of labor

The second stage of labor involves pushing and delivery of the baby.  The third stage involves the delivery of the placenta. 

At present, evidence is not as conclusive as experts would like with regards to hydrotherapy during the second stage of labor.  Additional research is needed.

It can be hard to weave through the language of medical research.  Most professionals agree that Randomized Control Trials (RCTs) will produce the most reliable evidence.  However, to date, most evidence about birth in water has been gathered from clinical audits and observational studies rather than these randomized controlled trials.  Some case studies are also being examined but they produce a very limited picture of water birth and should not be used as the basis for recommendations or practice decisions, cautions the American College of Nurse-Midwives.

Observational studies are considered more reliable and offer some of the best evidence about water birth at the present time. This evidence suggests that women who experience uncomplicated pregnancies and labors with limited risk factors and evidence-based management have comparable outcomes whether they choose to birth in water or not.

When it comes to the best available evidence, data generated by midwifery care provides the most accurate view of the safety of water birth because midwives practicing in birth centers are trained water birth providers.

The American Association of Birth Centers has gathered data on over 15,500 births among low-risk women birthing at a birth center from 2007 to 2010.  Of these births, nearly 4,000 were water births in birth tubs (57.6%), Jacuzzis (34.6%), and standard bathtubs (7.8%).

This data revealed the following:

  • Rates of postpartum and neonatal transfer from the birth center, and neonatal procedures were low in general, and were slightly lower for births in water when compared to non-water births.  This has been reported elsewhere.
  • If labor was not progressing smoothly, women were unlikely to give birth in water
  • Rates of newborn transfer to a hospital were lower after water birth (1.5%) than non-water birth (2.8%)
  • Rates of adverse newborn outcomes were below 1.0% in the water birth population.  The total rate of any respiratory issues was 1.6% in the babies born in water and 2.0% in those not born in water.
  • There were no cases of pneumonia, sepsis or other respiratory infection following water birth and there were no reports of ruptured umbilical cords or newborns breathing water into their lungs associated with birth underwater.

Safe Water Birth at Health Foundations Birth Center

At Health Foundations Birth Center, we follow the best evidence available in every aspect of care we offer to our families, including water birth.  Each of our midwives is highly trained and experienced in offering water birth safely and when appropriate to low risk mothers.

Along with the American College of Nurse-Midwives and the American Association of Birth Centers, we believe women should be given the opportunity to remain immersed during labor and birth if they wish to do so within the context of a shared decision-making process with their care providers. We also believe women have the right to make informed choices regarding water birth and are happy to discuss the best evidence available regarding hydrotherapy in childbirth with all interested clients.

We strictly follow the best practice guidelines we’ve learned in our rigorous educations, and as set forth by The American Association of Birth Centers and The American College of Nurse Midwives.  All of our midwives are qualified to provide education, risk assessment, and care to women who desire water immersion for labor or birth.

If you are a current client and have questions about water birth, please do not hesitate to call us or speak with us during an upcoming visit.  We want you to feel empowered to make informed decisions about all aspects of your care.

Sources:

The American Association of Birth Centers Position Paper on Water Birth

The American College of Nurse Midwives Position Paper on Water Birth

Birth Story: "We all have this maternal power~ we just have to believe in it..."

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The birth of baby Raina

Contractions started early in the morning on the 27th of November but never gained momentum – in fact, they stopped for most of the day – until Raina’s big sister Elya went to bed. Around 9:00pm then, I finally laid down and decided to get some sleep. The minute my head hit the pillow, however, my contractions started again. You have got to be kidding me, I remember thinking. I laid there for about an hour, trying to rest since they were only about 20 minutes apart, but eventually went out in to the living room to see my husband, Peter.

Once I was there and sitting on the ball, my contractions got stronger and closer together until eventually we thought, “This is it!” That’s when they spaced out again (around 11pm). I felt incredibly frustrated and worried that this “start-stop” pattern would continue throughout the night! Sensing my exhaustion, Peter kept urging me to lie down and sleep, but I knew that if I could just get my little girl’s head in the right position (pressing down on my cervix) I’d be in “real” labor. I therefore started doing squats during contractions, and in no time, was in full blown active labor, throwing up, and calling the midwives telling them “it was time”. This was around 11:30pm.

We got to Health Foundations birth center at 12:45am on November 28th, 2012 and my contractions were 3 mins apart. The minute I walked in and hugged my doula and friend, Aubrey, I started crying, feeling so grateful that she was there and that soon I would be meeting my baby girl! Amy, my midwife, immediately told me to get in the shower. "Why isn’t she starting the birth tub?" I thought, but brushed it aside and got in anyway; and thank God too, because the water felt amazing! My birth mix started playing (which was made for me by my best friends) making the whole scene surreal and emotional. Tears started streaming down my face, and I even managed to sing along to “Wade in the Water” by Eva Cassidy (in between contractions, mind you). I felt such joy and excitement for what was about to happen, it was unreal.

Finally, Amy and Aubrey told me to get out of the shower and try sitting down. There was NO way that was going to happen since Raina’s head was causing too much pressure, making any other position except standing unbearable. I leaned over the bed then, and put my head on some pillows. I squeezed Peter’s poor hand for the millionth time (he was smart and took off his ring this time) and Aubrey massaged my shoulders and neck, which felt amazing since I had pulled some muscles during contractions; again I started thinking, Why isn’t Amy running the water? I know I’ve got to be close. (Amy told me later that she thought I wasn’t even in active labor yet since I was being so “quiet” and “jovial”).

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Eventually I demanded they fill up the tub so I could get in. I also started telling them that I “couldn’t do this any longer” and that they had to “tell me what to do!” I knew from my actions that I was in transition but didn’t care. I needed my support team to tell me it was almost time to push so I could allow my body to do what it needed to. That’s when my water broke and I threw up again. I knew I was near the end, but since Amy still hadn’t checked my cervix I started doubting my intuition and resisting “the urge”.

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Once in the water, I immediately relaxed. Amy ‘checked me’ and told me Raina’s head was super low (which I was able to feel!) and that I was ‘complete’. What a relief! I thought. She then told me to start pushing with little pushes if I wanted to so I could ease into the “second stage”. This advice was extremely helpful and allowed me to gradually prepare for the “big push”, which eventually came from a source greater than myself – in 3 minutes then, I had my beautiful baby girl in my arms! I started crying, “Oh my God oh my God oh my God!” and kissing Raina’s perfect little head. Peter was crying too, and we kissed and marveled at the beautiful creation we had in front of us.

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Raina was born at 2:23am (7lbs 11oz and 22 inches long) after three hours of incredible and intense labor. It was the most amazing and gratifying birth ever. My first one was amazing too, but this experience had been exactly how I’d wanted it (except for the hope of being able to push without guidance. Nothing is ever perfect with Life.)

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I wouldn’t have had the birth of my dreams without Peter, Aubrey, Amy and Amanda (my midwives) by my side. I am also SO thankful that I now have beautiful and gorgeous pictures (taken by the lovely and wonderful Danica) to remind me of how strong and powerful I am. We all have this maternal power; we just have to believe in it, claim it, and trust in it, so we can fully let go in the welcomings of Life.

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All Photos by Danica Donnelly Photography

Birth Story: "How do you describe the ultimate miracle?"

The birth of baby Maia

by Jaime Fleres-Mizejewski

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I’m Late

Like many first time moms, I was fairly convinced my baby would greet the world sometime between 37 and 40 weeks and not a day later.  For some reason, I had it in my head that February 14, our due date, was the absolute last day she might arrive.  This, despite knowing first time mamas often deliver beyond their due dates.

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Week 37 came and went as I racked my brain for additional nesting activities—I’d been off work for weeks and there wasn’t another room to paint, rearrange or clean in the whole house! At this time, my intuition shifted too.  Though I was uncomfortably large (with a rockin' case of pubic symphysis pain) and baby was sometimes uncomfortably active, I had a new feeling she was quite content where she was.  I was unsure she’d ever want to leave her comfortable womb life.  Weeks 38 and 39 came and went.  So did our due date.

IMG_0216Like a slow motion film, the days crept by.  No baby.  Every day felt like Groundhog Day, the same day as the day before… again and again.  At first, I struggled: I was done with winter, done waiting; I was ready to hold my baby, ready to welcome this new chapter of my life.  It was crazy-making to spend every moment of every day prepared for labor and this radical life change to happen at any moment—like knowing an earthquake is going to hit, but not knowing when.

I spent a few days working myself into an anxious mess—I  actually cried through a lunch date, in public, with my hubby.  Nice one, J. I’d hit a low that wasn’t helping anyone and I resolved to forge a new perspective.  So I surrendered.  I simply decided to let it all go—the worry, the desire for control, the expectations, and the detrimental internal dialog.  I stopped telling myself “today is the day,” I stopped expecting labor at any moment, I stopped trying to will labor to begin, I stopped pretending I was in charge.  I just gave my best to surrender and trust in the mystery that is birth.

At about Day 10 post due, we had to start facing the reality that if she didn’t come in the next couple of days, we wouldn’t be able to birth naturally at the birth center.  Though this troubled me deeply, I tried to keep a vice grip on my new chosen outlook.  We had until Thursday February 28 to see if we could get this labor started naturally or we’d be looking at a hospital birth with medical interventions.

Inducing Labor

As of the Friday before, my cervix was showing no sign that labor was coming anytime soon.  We’d spend the weekend taking various natural measures to coax baby into the world (sex, evening primrose oil, taking walks, and acupuncture treatment). No labor.

By Monday morning, my cervix hadn’t changed, so we began the natural induction process.  For 24 hours, I wore a special catheter with two bulbs of water the size of limes pressing on either side of my cervix to help get it to soften and efface (open). The midwives and nurse said that if I opened to 5 cm it would fall out…but it didn’t.  It was an uncomfortable day.

The next morning, Day 12, I was only dilated to 1 or 2 cm, but my cervix had changed some so they removed the catheter and explained the herbal induction regiment I would begin.  This involved taking 4 ounces of castor oil.  The castor oil is meant to irritate the digestive system and so irritate the uterus, ideally prompting the latter into contractions.  I would also be taking some homeopathic medications and an herbal tincture, alternating the two every 15 minutes for 4 hours.

IMG_0247I was very excited and nervous to be starting this induction process, knowing that labor could be just around the corner.  I was advised to take the castor oil with a juice that I wouldn’t mind never drinking again.  I chose grape juice, since the only grape juice I like is called wine.  This combo was like taking a huge swig of motor oil and chasing it with Robitussin.  Yet, I guzzled down the whole concoction like it was a tequila shot and I was back in college.  It could have been worse.  It got worse.  The effect of castor oil is much like the worst food poisoning you've ever had.  Within 20 to 30 minutes or so, I met with something akin to Montezuma’s Revenge and spent much of the afternoon getting better acquainted with my bathroom.  It was quite a prelude to labor.

Early Labor

But it did the trick.  After kicking off the induction process at about 1 pm, early labor contractions began coming every 5 minutes by about 2:30 or 3:00 pm.  Billy and I spent the afternoon in our guest bedroom watching movies.  Well, he was in the guest room and I was mostly in the bathroom.  Labor continued through the afternoon.  At about 6 or 7, we went downstairs to cook a pasta carbonara dinner.  I made much of the dinner, stopping every few minutes to brace myself through contractions, which were still coming pretty regularly but were manageable.

After dinner, we returned to our little labor cocoon upstairs.  I spoke with our midwife, who suggested that I take another dose of castor oil (the opposite of what I was hoping to hear!) but in kindness, she cut my dose in half.  By 10pm, contractions had slowed a little bit, with some coming closer to 7 minutes apart, and I worried labor was waning.  But I kept my spirits up.  Billy and I decided to try to rest a little.

Active Labor

By midnight, labor had shifted from early labor contractions to more intense and frequent active labor contractions.  They were coming every one to five minutes, some lasting a minute, some a little less.  They were much more intense than the earlier contractions and required my focused breathing and vocalization to ride each wave.  Billy, half asleep, offered the verbal support I needed to stay confident and in the moment with each new rush.  Like a narcoleptic running a 100-meter dash, I managed to get through the intense physical exertion of a contraction, pass out for a few moments, and be jolted back into wakefulness with the next wave.   This lasted only a brief time, until I was just up, laboring hard, for the next six hours or so. I did well at staying present for each contraction and preventing mind chatter from adding any suffering to the physical pain.  I was just experiencing and witnessing this awesome primal process.

As morning crept up, Billy called our doula, Greta, and they decided together that this would be a good time for her to join us at the house, since labor was definitely progressing.  Until this point, I’d been laboring solely in the side lying position, which felt good and safe, but I wasn’t sure if it was ideal in getting labor to progress.  I really didn’t want to move, which was surprising since I thought I'd be more active through labor.

When Greta arrived, she suggested we try a few other positions.  We went into our bedroom and I got on the big birth/exercise ball.  I didn’t like being upright at all.  The pressure added by gravity was great and the contractions were more difficult to get through.  My mind began to resist, but I tried to trust that this was helping labor progress.  Since it was morning, we decided the shower might be a good change of positions, though Greta warned that it could bring on harder contractions.  It was hard to stand through contractions, so we brought the ball into the shower.  The shower felt great but labor was really intense so the experience was short.

Afterward, Greta suggested I sit on the toilet and labor there for a while, as it was a good position to keep labor rocking.  I did NOT like this!  It was the discomfort of the ball times ten and I felt too exposed and a little scared.  My mind frantically searched for a way out of this experience.  Something.  Anything.  I tried to negotiate with Greta and Billy—if I could just rest on the bed for a few minutes, I’d promise to return to this godforsaken position if we thought my labor was slowing down.  It worked!

Ah, back to the bed, my safe place. Labor only continued to intensify and I was able to remain in my little cocoon, wrapped in towels and blankets, howling like a warrior woman, with Billy and Greta watching over me.  At some point, maybe around 8am, Billy spoke with our midwife Amy.  Because of Billy’s calm demeanor in the face of nearly any event, he might have under-expressed the state of my laboring.  However, once Amy heard me in the background she likely gained a better idea of our progress.  Nevertheless, she suggested I try to eat something and then we would touch base with them again.   Greta, so kindly, spoon-fed me bites of oatmeal between contractions.  At this point, I remember keeping my eyes closed, totally disinterested in food, feeling utterly exhausted and increasingly nauseous.  In retrospect, I realize I was moving into transition.

Oneness

Whilst feeding me oatmeal, Greta intuitively asked if I was experiencing any strong thoughts or feelings I needed to express in order to move forward in labor.  I thought about it for a moment.  I could feel my dad’s presence very strongly at that time (he is in spirit) and I tried to communicate an ineffable experience.  I commented, “I know this is going to sound crazy, but I don’t just feel my dad around me, in some weird sense, I feel like I am my dad.” This sense of oneness with him makes perfect sense to me—not only were my dad and I really close, but I felt I was experiencing the same utter surrender and need for support in labor that he experienced with his cancer.  I understood him perfectly in that moment.

In the early days with Maia, I also experienced this same sense of oneness with her—like I understood her from the inside and that we were the same person in some way (which I suppose we’d been for quite some time!).  Of course, these oneness experiences all unfolded during the process of my bringing forth a separate being from my single body.  So, in a way it makes sense.  Birth offers a glimpse into the Mystery and an experience of Truth, in this case that we truly are all one, which is often just a pretty concept in my mind.

Transition

Anyhow, labor started to ramp up once again and it felt like my contractions didn’t end—they just went from a ten down to a seven and then back up again.  I was deep in a place within, tapping my inner reserves for all the strength and energy I could muster.  As things got really hazy (And loud!), I experienced something new: pushing.  At least two of my contractions on our guest bed went from “regular” squeezing contractions to all-out involuntary pushing.

“I’m pushing, you guys!” I was surprised and for a moment thought for sure I was going to deliver this baby right there on the bed!  I actually reached down to see if I could feel her head.  It felt that close.

It was really time for us to go.  But that was the very last thing I wanted to do.  The idea of actually getting up and going somewhere seemed ridiculous if not completely impossible.  “Please just call the midwives and ask them to come over,” I begged. They had to come to us; there was just no way I could move.  Despite my certain belief that I was immobile, I had such full trust in Greta and Billy that I complied when they insisted we go to the birth center.  They swore that I could do this.  I had to do this.

During pregnancy, the transition phase of labor made me nervous—I’d heard it was one of the most challenging times in labor, those moments when you were most likely to feel defeated, if not certain you were going to die.  And here I was looking at the prospect of actually getting in the car and travelling to a new place during this phase of labor.  Birth brings you right into your fears, forces you to look them dead in the eye, and offers you a chance to move through them.  When I knew that I needed to go (and go now!) I rallied and did what I needed to do.  I decided that after a contraction subsided a little, I needed to run downstairs and out to the car.  I was completely paralyzed during contractions, so this was the only way it would work.

Greta and Billy somehow dressed me, and I was ready to make a dash.  I only made it to the back door, before a contraction forced me to collapse on the floor for a couple minutes or more.  After it slowed down, I jolted up and ran through the backyard’s bright morning sunshine, hoping to at least make it to the car before another one started.  Just barely.  I jumped in the car, pushed the seat all the way back, and another double overhead transition wave came crashing all around me.  This one lasted, no exaggeration, the entire 5 to 7 minute ride to the birth center.  It just never let up.  I didn’t think, I just howled like mad through the contraction and hoped that the baby didn’t pop out on the floor.  Once we arrived at the birth center, I had a moment’s break to run to the door, through the reception area, into the birth room and on to the bed.  I barely made it.

At the Birth Center

We arrived sometime just before 10 am. Through a hazy half-glance, I saw Jill, our fabulous nurse, prepping to check my cervix.  “Jill, you better tell me I’m at a ten,” I muttered.  She checks and chuckles, “Oh yeah, you are there sweetheart.”  It was time for me to push (some more!).

I had a few more super intense contractions on the bed, as people came in and out of the room, preparing for the birth.  I was happy to see the familiar faces of Amy, Amanda, and Monica, our midwives, and I felt complete trust and peace in the situation.  I was in good hands and right where I needed to be.

Water Birth

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They drew a bath and suggested I get in for the pushing part of labor.  I was happy for this choice, as I wanted to deliver in water if it was a good option for us.  Though it felt a little scary to move, I made my way to the tub and got on all fours.  I labored like this for a while, as contractions turned to full force pushing.  Everyone was around me; encouraging me and helping me focus my energy during each intense wave.  Pushing is no joke; it’s like trying to move a mountain.  I resolved to give it every ounce of my strength and energy, giving way more than I ever knew I had.  Like contractions before, I had a good couple minute break to gather my strength in between each pushing wave.

My water broke in this position, and the team told me there was meconium in the water.  Meconium is poop the baby released in the womb, which can impede their airways as they take their first breaths.  Amanda calmly explained that it was going to be okay, they were going to suction her right away to clear her airways and then they’d hand her over to me.

maiabirth_0011I changed positions another two times, once to a reclined position the long way in the tub, with my hands bracing myself up and my legs spread.  (Fantastic birth tub, by the way!) Then, Amanda suggested I get into that same position the short way in the tub, so I could really open my pelvis and bring my legs up.  I was in this position for another half a dozen or so pushes, I think, before Maia was born.  Those last couple of pushing waves were the ultimate finale to labor—I gave everything I could and tried my hardest to push her out quickly but not too fast.  Greta later told me she felt like I had this amazing protective energy surrounding me and that I was in a deep place somewhere slightly removed.  Looking back, it feels like one of those dreams where you are hovering above your body watching things happen to you.

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I was able to reach down and feel Maia’s head a few minutes before she was born.  It was indescribable.  I held her, crowning, between a set of pushes, which the midwives said would help my tissues stretch.  I remember my strongest motivator at this moment was Billy—I could hear the joy in his voice as he caught the first glimpses of his daughter and I wanted so badly to give him the experience of seeing her.  It was a selfless and pure wish for him.

Maia is born

maiabirth_0021I pushed her out with the next wave.  Maia was born at about 11:11 am on Wednesday February 27, 2013.  It was an intense physical experience, but I was in the haze.  This haze makes it hard to describe with accuracy what happened next—and so many things seemed to happen all at once.

I remember seeing Amanda holding Maia up by her feet.  Maia was crying.  I didn’t see but I know they suctioned her.  Also, the umbilical cord burst when Maia was born, sending blood all over the place.  They clamped it, and before I knew it she was on my chest.

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I don’t know if I have words to describe the feeling of first holding Maia.  I mean, how do you describe the ultimate miracle?  It was pure joy, and awe, and wonder; I loved her instantly and intensely.  She was more beautiful than I could imagine.  I was meeting someone I’d waited my whole life to love.

Little Emergency

But the tub seemed to be getting darker and darker with blood, so they asked me to hand Maia to dad and get out of the tub.  I was still completely in the Birth Fog, so I just followed other’s directions without much thought.  But as soon as I got out of the tub, saw blood pouring all around me, and the flurry of action on part of the birth team, some distant part of me became a bit concerned.  As they helped me to a birth stool, I recall asking if everything was going to be okay, but the Fog blocked true worry from my mind.  I birthed my placenta, but my uterus had a hard time contracting as is necessary to avoid excessive blood loss.  I was bleeding profusely. So I received the full treatment—a couple of injections in my thigh and a gritty pill in my mouth, lots of painful pushing on my belly, buckets being filled with blood and tissue—and after a while, the hemorrhage emergency seemed to subside.  (Thanks to the competence and quick action of the birth team.  Total rock stars.)  This experience scared the bejeses out of poor Billy.

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Holding new life

I was helped to the bed and -- after a little more serious pushing on my uterus to ensure the bleeding has ceased -- I got to hold Maia again.  After that, she was really all I could focus on.  I was so exhausted and weak but I just wanted to hold and discover her.  Greta helped me learn how to nurse her and we worked on different holds for a while.  Maia was a fantastic and eager nurser from that very first try.  I am so grateful for that.  Billy and I snuggled in to stare in wonder at our new little love.

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The things going on around me are a little blurry in my memory.  I recall Amanda bringing over the placenta and showing it to us (she later encapsulated it for us).  I recall Amy telling me lots of important and helpful information I instantly forgot :).  I remember Greta offering me a tropical tasting drink and more water.  I ate pizza from Pizza Luce.  They gave Maia her first physical exam and she was healthy as could be (though they heard a heart murmur that would resolve itself in a matter of days).  Maia weighed eight pounds exactly and was 20 inches long.  She had a good cry from the start.

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I soon discovered another cause of my profuse bleeding—I had torn badly—through my inner and outer labia and a little on my perineum.  Apparently Maia stuck her hand up by her head as she was making her grand entrance and it ripped through my tissues.  Amanda also told me her head had rotated around as she came out of the birth canal, creating a wider space upon passage.  Amy spent at least an hour stitching me up—it took at least 40 stitches to get the job done.  She did a great job. This birth was beautiful but very physically taxing.

maiabirth_0079In all, we stayed at the birth center about 5 hours after the birth.  We left at about 4:30 in the afternoon and headed home.  We had great hopes of sleeping soon, as we were told babies usually sleep 6 to 8 hours at home after the birth.  Well, she didn’t exactly get this message until the next morning.  Eventually, after lots of exhausted activity I cannot really recall, we slept from about 4am to maybe 10am, the longest stint of sleep we’d have for weeks to come.

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But alas, our beautiful baby girl is in the world.  We had an amazingly beautiful birth experience and came out stronger than I thought possible.  Billy was so proud of me in the coming days; it was the greatest feeling in the world.  Maia and I did it.  We did it together surrounded in love and support from some truly remarkable people.  It doesn’t get any better than that.  I am so grateful.

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Most photos by: EyeSpy Photography