Birthing Beautiful Ideas

Today I am excited to share with my readers a birth story from one of my doula clients!

It’s a special story–one that I often recount to other pregnant women, doulas, and birth advocates.

(Before going on, I should note that all of the births that I have attended are special and near and dear to my heart, and every single woman whose birth I have attended has demonstrated the most humbling and awe-inspiring strength.  Birthing women are amazing.  Birth is amazing.  Period.)

But the birth described below was also special because of its unique circumstances.  Just consider everything that Jessica (the mother in the story) had faced or was facing on the day she went into labor:

• Her husband had been deployed to Iraq for months and would not be returning to the United States for another few months after the birth of their son.
• She had a fifteen-month-old daughter at home, who had been born, with Jessica’s husband present, in another state in an out-of-hospital birth center.
• There were no out-of-hospital birth centers in the state where Jessica resided at the time of her second child’s birth.  The only comparable option was an in-hospital birth center.
• Because Jessica’s baby was measuring “large for gestational age” (the estimate was between nine and ten pounds) in the last couple weeks of her pregnancy, the primary OB/GYN in her practice risked her out of the in-hospital birth center.  According to him, this was because “the beds in the in-hospital birth center”–which was immediately adjacent to the regular labor and delivery unit–”were not equipped with stirrups to handle shoulder dystocia.”
• Because Jessica’s baby was measuring “large for gestational age,” this same OB/GYN tried to talk her into an elective cesarean delivery.  She declined, but not after having to fight for the right to deliver her child vaginally.
• The OB/GYNs and midwives in her practice strongly encouraged her to undergo an induction, again citing her baby’s size as a cause for concern.  Jessica–now over one week past her estimated due date, and tired of fighting off their scare tactics–agreed to an induction by amniotomy.  She was committed to not having pain medication, and didn’t want to have to fight through the extra-intensity of a pitocin induction.

Jessica and I talked at length about her OB/GYN’s recommendations.  We talked about some of the research about “suspected fetal macrosomia” (or suspected “big baby”) and different modes of delivery.  We talked about  the fact that she had already delivered a “big” (9 lb.) baby vaginally.  We talked about her blood sugars were normal when she was tested for gestational diabetes.  We talked about how remaining upright and mobile during labor and delivery would give her the advantage of gravity and allow for greater pelvic mobility to assist with the rotation and descent of her baby.  I even remember reading aloud sections from The Thinking Woman’s Guide to a Better Birth!

We also talked about her wishes and her feelings about this birth.

And it was quite clear that she wanted to avoid an unnecessary cesarean section.  She also wanted to avoid an induction, but she was willing to undergo one if it meant ultimately warding off her care providers’ pressure to have a c-section.

But then her body had plans of its own.

This is Jessica’s birth story, in her own words.

Evan’s Birth Story

April 14, 2009

I woke up at 7 a.m. when Irelyn started fussing and noticed by back was achy and I was having some mild contractions.  Since I had been having prodromal labor  for a few weeks now, I ignored the contractions because I didn’t want to allow myself to think that I could be in labor; I had been disappointed too many times lately.  So, Irelyn and I snuggled and watched tv together on the couch.  It was about 7:30 a.m. when I stood up to go to the bathroom and noticed some wetness in my underwear.  I thought for a second that maybe my water broke but really didn’t know what to think since it was such a small amount.  So I went to  the bathroom and when I stood up from sitting on the toilet, I got a bigger gush so I knew then that my water really did break.  I was so excited tat today was going to be the day, but also shocked and nervous because it seemed like this day would never come!  I called my doula to give her the heads up and told her I was going to go about my normal morning routine and would call her when my contractions picked up and thought I needed her.  I also called my mom and said the same thing.

I proceeded to put Irelyn in her high chair and give her breakfast when I got another big gush of water.  Almost immediately the contractions got so much more intense and closer together.  I went and sat on the toilet and the sitting gave me so much relief that I didn’t feel like I could get up.  I called my mom and doula and told them to come over now because it seemed like things were really going fast.  Meanwhile, Irelyn was such a good girl strapped in her high chair with mommy unable to get up from the toilet.  I think she knew something was going on and decided not to throw a fit or fuss despite having already eaten all of her breakfast.  I could see her from the bathroom so I just worked through contractions and talked to her until finally my mom showed up.  By this time was was about 8:30 a.m.

I jumped in the shower while my mom got all of Irelyn’s stuff together so my stepdad could take her.  I just stood there and worked through some more contractions while the hot water pounded on my back, it felt so good!  But things were definitely progressing fast.  There were a few times my body just went into a squatting position and I was terrified that I was going to end up having this baby in the shower!  So I told my mom to get the car ready because as soon as I could get myself out of the shower we were going to head to the hospital; there was no time to relax and labor at home as planned.  Meanwhile I could hear Irelyn running around the house and I couldn’t believe everything was happening so fast that I wouldn’t even be able to say goodbye to her, so I yelled for my mom to bring her into me and my mom stuck Irelyn’s head in the shower so I could give her a kiss goodbye.  It definitely wasn’t the goodbye I had planned on or wanted to have, but I really didn’t have time to get overly upset about it since the contractions were taking over completely.  My doula showed up when I was getting out of the shower and her and my mom walked me out to the car.  My contractions were right on top of each other at this point and really painful.  It took me about ten tries to climb into my mom’s car; I just didn’t want to be trapped in that car, I needed to be moving around for relief.  But I knew I had to get in if I wanted to have this baby so I sat on my knees with my chest up against the back seat and hugging the head rest.  The hospital is only five minutes away and my mom flew there but it still seemed like eternity.

My doula told her to go to the ER entrance because I was already feeling the urge to push.  So we pulled up to the ER and they brought out a wheelchair, took one look at me and ran and got a stretcher.  The nurses whisked me up to L&D on the fifth floor, where they already had a room ready for me since my mom called on the way to let them know we were coming.  They moved me from the stretcher to the bed and the doctor checked me and said I was only 6 cm!    NO WAY!  I freaked out because the urge to push was definitely there, how could I only be 6 cm?  I had to lay on the bed for ten minutes while they drew my blood and hooked up a fetal monitor.  That ten minutes was the most excruciating time of my whole labor because laying down compounded my pain so much.  I looked at my mom and doula in the eyes and begged for some pain relief.  I didn’t necessarily want an epidural but I needed something, I seriously couldn’t  take the pain any more knowing that I was only 6 cm.  I felt like I had so much longer to go.  My doula and mom, having met with me several times before the birth and knowing I wanted to go natural, encouraged me to keep going without the medication and just go give more minutes, then just ten more minutes.  Again, I looked them in the eye, crying, and insisted that I needed something and tha tI would be okay with no having a natural birth.  At that moment my contraction died down and the nurses were done getting readings off their monitors and I was able to sit up at the end of the bed.  Sitting up took so much pressure  off my back and the pain immediately lessened.  My contractions were still one on top of the other and my doula helped by guiding my breathing.  She kept saying to breathe on top of my contractions, and I guess that can be up for individual interpretation but I just visualized slowly blowing out my contractions like slowly blowing out a big fire.  I got  through three contractions this way and then really felt the urge to go to the bathroom.  This was about 10:15 a.m.

I squatted on the toilet to use the restroom and as soon as I did that my body took over and just started pushing.  The nurse told me not to push and I told her she needed to check me because this urge was undeniable.  I couldn’t not push.  She checked me and immediately said to get back to the bed, that it was time to have this baby!  The doctor checked me and said I was 10 cm and that I could pull my legs back and push on my next contraction.  I was in a sitting up position so I pulled my legs back with the help of my mom and doula and also two nurses who pushed my feet back.  While I was getting ready to push, my doctor took a huge bottle of oil and poured it on my perineum and started massaging it pretty rigorously; he knew I was expecting a big baby and he didn’t want me to tear.  On the next contraction I pushed I pushed and immediately felt the ring of fire.  I was screaming during the next push and the doctor and nurses told me not to scream and to put that energy towards my pushing.  At this point his head was halfway out.  I gave one more long hard push, making no noise, and out came his head;  another push and out came the rest of him!  He was born at 10:32 a.m., three hours after my water broke and one hour after arriving at the hospital at 6 cm!  They immediately put him on my chest and all I could think was thank God it’s over; it was the biggest relief of my life!  The placenta was delivered fairly quickly after and the doctor announced that I had no tears!

After some mommy and baby bonding time, they did all of his measurements.  First came his weight.  The scale read 11 lbs. 9.8 oz. and the nurse didn’t believe it so she unplugged the scale and recalibrated it!  She then put Evan back on the scale and couldn’t believe it when it gave her the same reading.  And I have to admit, I was pretty surprised myself!  Then came his length.  The baby measuring tape goes up to 24 inches, and that’s exactly what he measured!   I can’t believe I had two feet of baby inside of me!  His head measured 14.5 inches.

The doctor that delivered Evan was the only doctor that I had yet to meet at my practice but he was so nice and I will be forever thankful for how he stretched my perineum so I wouldn’t tear.  In fact, there was a resident watching the birth and when Evan’s head started to crown, he got a pair of scissors and handed them to the doctor (for an episiotomy) and he told him that he wouldn’t be using those.

Ironically, the doctors did a shift change about ten minutes after Evan was born.  The doctor that I met with the previous week that thought that I should have a c-section and the one who denied me being able to birth at the birth center was now the one on the floor.  Thank God he was born right when he was or that doctor would have been the one delivering him!  I guess everything happens for a reason.  He did come in because he wanted to see what such a big baby looked like and my doula made it a point to tell him how proud she was of me giving birth naturally to such a big baby and how no shoulders got stuck and I had no tears.  It was kind of an in-your-face type conversation, and I loved every minute of it!

My doula thinks that scheduling my water to be broken and knowing that there was an end in sight was probably just what I needed to relax enough about the birth to go into labor on my own.  And the nurses think that my urge to push at 6 cm was probably the true urge to push given how big Evan is.  His head was that low in my pelvis but I still needed to dilate more to get the rest of his body through.

As for my recovery, I am doing absolutely wonderful!  I have no post-partum care and nothing that is holding me back from doing anything.  Between delivering Evan and losing all the amniotic fluid that I did when my water broke and throughout labor, I have already lost 30 lbs and guess you can’t beat the birth-an-11-pound-baby-weightloss-program!!

She avoided an “unnecesarean”!  She birthed an 11 lb. 10 oz. baby vaginally–and with an intact perineum!  And she did it all with the pressure to have an elective cesarean section, an induction, and even an episiotomy standing in her way!  She is a warrior!

Here are a few of my additional thoughts on this very special birth:

• One of the reasons I asked Jessica’s mom to drive to the ER entrance was that the distance from the parking garage to the labor and delivery unit was rather sizable.  It would have been a long walk.  And what might that have meant for the woman was holding her baby only one hour after arriving at the hospital at “only” 6 cm dilated?  Probably a baby born in the hospital hallway!
• During the nurse’s initial monitoring, all of the residents and other medical professionals in the room kept whispering about how she was “only” 6 cm dilated–as if that were somehow disappointing!  And every time that someone uttered the word ‘six,’ Jessica seemed to lose her focus.  (It didn’t help that she had limited mobility during that period of fetal monitoring and blood draws and hospital questions!)  I wish that these people had known that Jessica’s “birth behavior”–and the sensations she was describing–was more indicative of “how far along” she was in her labor than her cervical dilation.  She was, in fact, holding her baby less than one hour after being told that she was “only” 6 cm dilated!
• Despite Jessica’s requests for pain medication, I kept encouraging her to forego them–not because I was irrationally committed to her going without drugs, and not just because she had expressed the desire to avoid pain medications during our prenatal visits.  I encouraged her to try for five and then ten more minutes without drugs because I had the exceedingly strong feeling that “her six centimeters” was not “every woman’s six centimeters.”  In other words, she was not laboring like a woman in a long, drawn out active labor–she was laboring like a woman in transition, and one very close to pushing her baby out!  What’s more, I knew that once the nurse finished her monitoring, and once Jessica had more freedom of movement, she would be able to cope better with her contractions.
• 11 lbs. 10 oz.  24 inches.  With an intact perineum. Need I say more?!
• I love that the obstetrician catching Jessica’s baby shooed away those episiotomy scissors.
• And I also loved bragging about Jessica’s amazing accomplishment with the other obstetrician.  How could a snark-loving doula like myself not enjoy that?

So yes, a lovely birth indeed.  One just as lovely as all of the births I’ve attended, but one in which the mother overcame more obstacles and hurdles than any other birth I’ve attended.

And I am so proud of Jessica for that.

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In closing, it would be great if you could send a heartfelt congratulations Jessica’s way in the comments section.  Her son, Evan, just celebrated his first birthday this week, and she is expecting her third child later this Fall!  She is one hard-working, amazing birthing woman!