Since I’m going to write a ridiculously detailed account for my own benefit, I’m going to give the Cliff’s notes version up front for those with less interest in all the nitty-gritty details: I had a great birth experience! A number of things didn’t go as planned, there were a few hours of pain to exceed all pain I have ever EVER experienced, but I felt strong and confident most of the time. When I think back on it, I believe it will always be a cherished memory for me: how hard I worked to get this baby here, how supportive Neal and my doulas were, how we made good, clear-headed decisions in the moment even when they were different than our “ideal” plans.
So when I last wrote about my labor on Monday the 15th, it was about 12:30 pm and contractions were about 6 minutes apart after coming consistently and painfully since about 3:30 am. I was still worried then that this might not be the real thing since one of my friends had been having this type of experience for more than a week. But it wasn’t too long before we knew that this was it. Soon we were really busting out the coping techniques. Some ended up seeming worse than irrelevant in the moment; for example, we both laughed at the Non-Focused Awareness technique we had practiced because in the moment it seemed really silly for Neal to read from a script. But many were genuinely helpful:
- Touch relaxation (from Birthing from Within) — Neal would stroke my lower back in time with my breathing to help me get through the contraction. The sensation drew my attention away from the contraction’s pain as well as helping me keep the rhythm of my breathing.
- Counterpressure on my back — this was huge because I was having so much back pain even between contractions.
- TENS (Transcutaneous Electrical Nerve Stimulation) unit — not everyone has access to one of these but because I’ve had so much physical therapy for my back problems, I have a home unit. It didn’t do all that much for pain relief during the contractions, but it made the back pain far more bearable in between contractions.
- Birthing ball (aka. exercise ball) — swaying helped me keep a rhythm going and just sitting on something that had some give to it was far more comfortable than the couch or standing.
- Warm compresses — my friend Hilary recommended getting a crockpot going with warm, wet washcloths. This suggestion = AWESOME! Sometimes Neal would put them on my stomach, sometimes on my back in conjunction with the counterpressure.
Neal was at my side continually from mid-day and although at times we considered calling my doula Melissa (we talked through a strategy with her about 6:00 am, but were trying to labor without her as long as we could), I felt that we were coping pretty well with just the two of us. By about 2 or 3 in the afternoon, my appetite was gone but luckily I had done some carbo-loading in the morning to give me the energy to get through.
Around 4:30 with the contractions coming about every 5 minutes, we decided to go for a walk around the neighborhood to try to kick things up a notch. Um, wow, walking REALLY kicked things up a notch! The contractions moved to every 1 to 3 minutes and were getting crazy intense. Luckily, I had Neal there to lean on and encourage me with statements like this: “If walking in labor were an Olympic event [remember this was during the Vancouver Olympics], you would definitely make it to the second round. You probably wouldn’t medal or anything, but the second round . . . that’s really good because there are some first-class athletes out there.”
When we got done with our walk, the contractions stayed at about every 3 minutes and their intensity didn’t decrease much. I was getting waaaay uncomfortable. I kept moving positions constantly because I couldn’t figure out whether I wanted to sit or stand or lay down. We gave Melissa another call about 6:30 and she was genuinely shocked to hear that I had been laboring all day. It turns out because I hadn’t called her again after the 6:00 am call, she thought that the contractions had died down again, as they had been doing all weekend. I still wasn’t sure if I wanted her to come right then — I think because it was my first time, I was really paranoid about calling my doula in too early, or going to the hospital too early, or even making Neal stop doing his homework too early. But we agreed that Melissa would get dressed and ready to come over and wait for our next call.
About 30 minutes later (7:00ish for those keeping track), I was sure we needed her to come. The contractions were still every 2-3 minutes and intense, but now I also had the shakes — bad. I alternately felt cold and hot. Melissa had just gotten home from her other job and said she would get ready and come as soon as possible, as well as call in the apprentice doula. We talked through whether we should just meet at the hospital, but I was still worried about going in too early, so we agreed to labor at home for a while longer [I didn’t mention this to Neal because he was getting nervous and probably would have thought I was ridiculous, but I was kind of hoping to labor at home long enough to see the Olympic pairs figure skating competition. In hindsight, I also think I’m ridiculous, but I was really rooting for that Chinese couple!]
But just 20 minutes later, things were getting even more intense and when we called Melissa back, she suggested that we meet at the hospital because based on how I sounded, she thought that I was progressing quickly. Neal got some chicken broth ready and bundled me in the car. We got to the hospital about 8:00 pm, and thankfully, the contractions stayed strong and steady at about every 2-3 minutes [I was worried that my discomfort with hospitals would make me tense up and undercut my body’s natural process, which was obviously humming along].
When they checked me in the triage room, they determined that yes, this was the real thing and I was fully effaced and 5 centimeters dilated. They asked if I wanted a wheelchair to get to my permanent room, but I was really proud of myself that I was still feeling pretty strong and walked with the support of Melissa and Neal. Around this time, I also met my apprentice doula Krisell (I’m not sure if this is how her name is spelled since I never saw it in print) for the first time. Mine was the first labor she was attending, but she was an absolute natural. Melissa and Krisell would push against my knees to provide counterpressure during the contractions, gently massage my hands and feet in between contractions, and give soft words of encouragement (all the better because of Krisell’s awesome South African accent). Before labor, we had talked through what I thought my support preferences would be, i.e. I like touch and massage and probably wasn’t seeking quite as much verbal support, particularly not really loud cheerleading. I was prepared for being totally wrong about what would actually help in the moment, but my preferences stayed pretty consistent. I loved the calmness that both Melissa and Krisell exuded.
Melissa’s mellow nature was what Neal and I were first struck by when we met, and one of the key reasons we chose her over other doulas we interviewed. And boy, were we glad because we very quickly encountered some frustrations when Heather, the midwife on call (that I had this unpleasant first meeting with), arrived. Jana, my regular midwife, had foreseen that Heather and I wouldn’t get along well too well (not that I’m a difficult person, but you will see shortly that Heather and I were not a good fit for birthing) and told me that we could call her for the delivery. But as fate would have it, she was out of town during my delivery.
So more or less, this is what happened when Heather arrived: the nurse had given her a copy of my birth plan and she was holding it, when she came to explain that 1) I could not get in the shower or take a bath, 2) I had to have continuous fetal monitoring, 3) she wanted me to get an I.V, and 4) she pretty much wanted me to stay in bed. If anyone is in doubt about my birth plan, this was pretty much the opposite of everything I had discussed and planned for with Jana and Sarah (the other midwives I saw). What’s more Heather told me that these were not her policies, but the requirement of the new back-up physician, and if I didn’t agree, she would have to transfer me to his care immediately and he would treat me as a high-risk delivery with a lot of interventions that come with that.
Let me tell you, I could go on for a long time about how silly this scenario was, especially considering all that I have learned about Heather and her methods of practice since then. What it boils down to is this: she does not really advocate a collaborative, midwifery model of care. Which makes one wonder why she decided to, you know, work at a MIDWIFE clinic. But whatever.
The really miraculous thing, and probably one of the things that I feel most proud of, is that, with the amazing help of Neal and Melissa (and probably God, I’m sure he was involved too), I didn’t get angry or combative or even very disappointed. In between the still-frequent contractions, I asked legitimate questions, like “Why do you have baths and showers if you won’t let people use them?” and “Can I use the telemetry machine so that I can be fetal-monitored while moving freely?” Melissa warned us that some OBs can be punitive with patients they don’t agree with, so she felt that we were still better off with Heather. Ultimately, we agreed.
I had come prepared to compromise on the I.V.; in fact, I had been thinking that it would be best for me to get that upfront since I have really (REALLY) difficult veins. But refusing one in my birth plan was a strategic move that I hoped would make them feel like I was compromising (and/or they were winning) when I consented to a heplock. It seemed to work. They also agreed to the telemetry machine so I could still walk around and use a birthing ball. The nurse also told me that whenever I needed to use the bathroom, I could unhook from the monitor, so we decided that we might spend some time in the bathroom.
They brought in the birthing ball and I got positioned on it, leaning back against Neal who was sitting behind me. Initially, Melissa and Krisell would press against my knees during the contractions. But as they kept intensifying, Melissa started to do counting breathing, holding up a different number of fingers with each contraction and having me breath that many times through the contraction. Not that things hadn’t been hard before, but it was getting tough and I was also starting into some double-peaking contractions, which were pretty ridiculous. Heather wasn’t in the room with me all that much, but did come in periodically because she was annoyed that I was moving and the monitor would stop picking up our heartbeats.
It was somewhere around 9:30 pm that she whirled in and said that the baby’s heart rate had plummeted to 90 beats per minute and that she needed to break my water and insert an electrode into baby’s scalp immediately. Well, right then Neal was watching the fetal monitor and it was registering a really steady 140, and my whole team (Heather was not really part of my team, although Jana would have been) was like, she’s full of crap. Neal and I know without a doubt that Addison was never in distress during the delivery. It’s just one of those things that we know. It was completely obvious to us that Heather was just annoyed that I kept moving and the monitor was switching back and forth between the baby’s heart rate and my heart rate. [Interestingly, too, they never brought in the telemetry monitor, despite a couple of requests and after telling us they would. Just one of the things that further confirmed that Heather’s goal was for me to get in bed and stay in bed.] Of course, Heather assured us that the baby wouldn’t feel something being inserted into her scalp (because babies magically can’t feel anything until they’re born — okay, see, I need to not be retroactively sarcastic since I did such a good job of not being annoyed or sarcastic during the actual labor :)). It turned out my water had already broken (a slow leak, something I had suspected but wasn’t sure about), so it didn’t drastically alter the labor’s rhythm. Still it seemed to appease Heather, and she didn’t come in to bug me about the fetal monitoring anymore.
However, it was not too much later, about 10:00 pm, that she came in to give me the song-and-dance about how I was not progressing quickly enough. In two hours at the hospital, I had progressed another centimeter to 6. Melissa was genuinely shocked that Heather would come in and disrupt my rhythm and try to undercut my confidence when it was clear I was making progress. At this point, Heather basically wanted me to get an epidural and a gentle push from our synthetic-friend Pitocin (now I think Pitocin can be a great and helpful thing, but in my case, we all felt that her encouragement had a lot more to do with her timetable than with my labor’s progression). Melissa assured me that from her observations I was doing well and progressing quickly — I really admire the fine line she walked through the whole labor, not directly defying Heather, but quietly reminding me that I should trust how I was feeling rather than being unduly influenced by Heather’s perceptions. I told Heather I just wanted to keep laboring as is, and would reevaluate in another hour.
Sure enough, just about 30 or 40 minutes later, the nurse checked me again and said I was at a 7. This was gratifying, but at the same time, I was starting to feel more than a little bit of agony — and as Neal assured me later, probably everyone in the birthing wing could tell by the way I was expressing myself. Funny, I don’t remember being very loud :). It’s a bit of a blur for both Neal and I about how they figured this out, or perhaps why they only figured it out at this point rather than earlier, but right about this time they said that baby girl was posterior and not turning. It seemed like an “A-ha” moment for everyone else that explained why my pain and contractions were so intense but we weren’t quite as far along as they would expect. I remember someone, can’t say who, asked me why I didn’t tell them I was having “back labor” this whole time. Well, probably because it was my first labor. Duh.
I’m trying to figure out how to articulate the sensation that I started experiencing around this time. Throughout the day and night, I kept feeling like I needed to go to the bathroom. But nothing really happened on my many trips to the toilet. But always I felt this intense need to have a bowel movement. Well, in pretty short order, with each contraction, my whole body started to push, as if I was going to the bathroom (I wasn’t) and throwing up at the exact same moment. After a few of these full-body spasms, I knew I had to get off the birthing ball, so Neal and the doulas helped me into bed. I lied down [who can explain to me the proper lie-lay usage? it’s one of my grammatical Achille’s heels] for a few minutes but the “spasms” kept coming even stronger, and my vocalizations kept getting louder, bringing Heather and the nurse back into my room. My main memory at this point is everyone frantically telling me not to push while I tried to explain that I wasn’t pushing, that my body was just doing whatever it was doing. It seemed sort of like someone telling me mid-vomit to just stop heaving.
They checked my cervix again and told me that I was back at 5 centimeters and my cervix was thickening and swelling up. I don’t think I realized that you could actually regress. Thinking back on it, I could have been really disappointed that I went from a 7, almost 8 to a 5 in just a few minutes. But at the time, I felt no disappointment because I was OUT OF MY MIND WITH PAIN. Around 11:00 pm, about 20 hours into active labor, I told Neal, “I don’t think I can do this anymore.” I’m not sure exactly what I thought would happen when I said that because I didn’t ask for an epidural, or necessarily plan on getting one. I think part of me, quite irrationally, thought that when you admit it, maybe you sort of get a little break. Not so much :).
Neal, Melissa, and Krisell, of course, assured me that I could do it. But I remember that I had reached that point where I just felt like I couldn’t and no amount of encouragement revitalized me. At this point, Heather presented us with two options: 1) I could keep laboring like I was and probably end up with a c-section in an hour or two (since, after all, I was now going backwards) or 2) I could get an epidural now and see if that was enough to stop pushing and get my labor out of its dysfunctional pattern. Heather ultimately concluded that Addison’s posterior positioning was putting so much pressure on my rectum that it was causing this sort of involuntary pushing; the epidural was the last option before a c-section. Neal and I consulted briefly about it, but I was ready to consent to the epidural.
Knowing how things turned out (well!), we are inclined to believe that Heather was right. I was on my way to a c-section if the epidural didn’t work exactly right. But I think that our biggest regret is that Jana was not the midwife with us because if she had given us the same two options, we would have known that she was being straight with us. We would feel sure that she was helping us make the right choice for me and the baby, uninfluenced by her preferences or convenience.
I quickly learned that there are a couple of crummy things about getting an epidural after laboring unmedicated for so long. First, once you accept that you need the epidural, you want it IMMEDIATELY, like yesterday! It seemed impossible to get through another full hour of contractions/pushing/convulsions/shakes waiting for the anesthesiologist. Second, you think, why in the H-E-double-hockeysticks did I go through all that pain without medication, just to eventually get an epidural? WHY? WHY?
Although that last question crossed my mind more than a couple times, I honestly don’t think I would do things differently if I had to go back and do it all again. Things moved really quickly from the time I got the epidural, about 12:40 am. I was fully dilated in 20 minutes, confirming what Melissa kept telling me, that my body was really charging ahead and pumping the oxytocin like nobody’s business. The baby was still posterior, but Heather wanted to go ahead with the pushing. She told us to take a 10-minute break while they prepped and then we were going to get going with the pushing.
Since I was considerably more comfortable after the epidural, Neal left my side for the first time in like 12 hours. He told them he was just going to use the bathroom and would be back in a minute. Consequently, he was more than a little flummoxed when he returned and found that they had already started me pushing before the 10 minutes were up. [Like I said, Heather was kind of on her own timetable. In her defense, she had been at the hospital for 48 hours straight and I was her 7th delivery, but still.]
So around 1:10 am, I started pushing. For all our frustrations with Heather, I will say wholeheartedly that we think she did a GREAT job at this point. Various people mentioned that the back-up doctor was basically waiting outside my room, assuming that I would either need a c-section or forceps-assisted delivery. But Heather was willing to try and manually turn the baby as I pushed. She would prompt me to give “one big push now” or two little “grunty” pushes; she would tell me to push harder or softer, all in an effort to get Addison turned and out without additional intervention. Although I couldn’t see what was going on down there, at a certain point Heather and the nurses started telling us that “Addie” was so smart, that she knew what to do, that she was turning herself even though she was so far down the birth canal. They were also impressed with how well I was able to push; it surprised them that I knew right where to bear down even though I had the epidural. But really, I hadn’t even had the epidural for an hour yet, and I had already been pushing down there for awhile so it probably shouldn’t be too shocking that I could still feel where all the action was happening.
At the point of crowning, Heather said that even though she wasn’t someone who regularly cut an episiotomy, she thought I needed one to avoid a more severe tear. She told us that if the baby didn’t crown after one more big push, she would cut an episiotomy, which is why Neal was more than a little shocked that she cut the episiotomy right after she said that. But everything went so fast after that; a minute or two later, almost before I realized what happened, they were putting Addison on my belly. 1:52 am.
For a first-timer, I felt very blessed to push for just 40 minutes and only have a second-degree tear. [And for those friends who recommended the sitz bath for healing, THANK YOU!!! Those helped sooo much!] Even though most of the labor felt very long, the last bit seemed almost like a flash. It was very surreal for both Neal and I to see her finally out. We almost couldn’t believe that such a fully-formed, strong little girl just came out of my belly. I think it was even more jarring for Neal since he had always insisted on thinking of her as a “belly monster” — and she ended up looking much more like a human baby than a monster.
So that’s my story. Since it has taken me over two months to get that much properly recorded, I’m going to post this and then follow up soon with a few of my final reflections on the whole process.