Birth Story #2

 

Forty weeks.

Content Warning: This post contains an emergency birth situation. Spoiler, everyone was fine. Also, so many lessons learned. This birth will forever inform the way I am able to give care to my clients.

Confession, I like to plan. I am also a bit of a perfectionist. When I planned the home birth of my second child I wanted it to be perfect. I knew that every birth is different and each has its own challenges. I thought if I had everything I needed, and most of the possible scenarios accounted for, then I should have a smooth birth experience. Everyone kept telling me the second baby is easier. The birth of my first child almost two years before was beautiful but not the experience that I had envisioned for myself.  After 20 hours of painful and tiring labor, I got an epidural, and waited another 17 hours to push out my baby with the help of Pitocin. This time I really wanted it to be different. And, I did not want to go to the hospital. In the weeks and days leading up to the birth my midwife and OB were both optimistic for an eventless birth and I felt healthy and strong. So, the wait began for labor to start.

Forty weeks pregnant came and went. The days following my estimated due date I had contractions ranging from mild to strong and they were pretty inconsistent. We did all of the usual natural labor inducers to help get the baby moving. Nothing was kick-starting labor. On the morning exactly one week past my estimated due date, regular contractions set in and did not go away. My sister was staying with us and we took my two year old to the playground so my husband could do some last minute cleaning and get the water going in the birth pool. While he played I walked laps around the playground hoping the walking would help labor progress a little faster. I was really hoping for a shorter labor this time around.  After about an hour we went back to the house, got lunch, and put my son down for a nap. I really don’t know what I did at this point, besides eat some lunch. I did call my midwife, because contractions were 3-5 minutes apart and lasting about 1.5 minutes. She decided to come and check my progress. She was an hour away and I was hoping to progress some while we waited. When she arrived she checked my cervix and I was about 2.5 or 3 centimeters dilated. I was disappointed since I had been having strong regular contractions for most of the day. She suggested separating the membranes between my cervix and bag of water, and I agreed. This is not a comfortable procedure. Some people call it stripping the membranes, however nothing actually gets stripped away.  At some point my doula showed up and at 3pm I decided to take a nap.

I was able to rest a little bit because my contractions slowed down when I was napping.  I woke up to a really strong contraction and the need to pee. I went to the bathroom and as soon as I stood up and stepped away from the toilet my water broke. It was 4pm. I couldn’t believe how much water came out of me! Everyone who needed to be at my house for the birth was there, the birth pool was full of water, and we had childcare arranged for my son. Everything was in place for a perfect home birth. My contractions were much stronger and my midwife suggested getting in the shower before getting in the pool. She said we would wait for the pool for when I was much further along because the warm water could slow down my labor. I stayed in the shower for at least an hour, if not longer. It felt really good on my back and I used up all of the hot water standing under the spray. When I got out my midwife checked my cervix and I was 4 or 5 centimeters. The contractions were quite painful at this point. I was focusing on staying relaxed and breathing through each one. For the next couple of hours I paced around the living room while my birth team encouraged me. My doula massaged my lower back during the contractions and that was really helpful. The midwife’s assistant suggested squatting during the contractions because it would help open me up and help with the pain. I was in a lot of pain at this point.  Getting into a squat was very difficult and the contractions made it difficult to stand or even think straight. I felt very nauseous and I wasn’t sure I would make it from one contraction to the next. It felt like I was wearing blinders. I could only focus on what was directly in front of me and I had no concept of time or what anyone else was doing. I know my doula and my husband were by my side the whole time. When I needed a hand to squeeze or shoulder to lean on one of them was right there for me to grab. I tried to keep my gaze soft and relax my muscles as much as possible during the contractions. And it felt like this was one of the most difficult things I had ever done. In my head I was thinking about opening up, but I am pretty sure I kept telling everyone I couldn’t do it anymore.

At 8:30pm my midwife I was far enough along to get in the birth pool. The warm water was relaxing and it definitely helped take away some of the pressure that I was feeling. The pain seemed unbearable.  I was 7 centimeters dilated. The midwife was checking the baby’s heart rate every 15 minutes with a handheld doppler. Between each contraction I swore aloud that I would not be able to go through another one because it was so painful. With each contraction I looked forward to next cold washcloth that someone was placing on my neck. They had to keep changing them because I was so hot they weren’t staying cold very long. My doula and husband were in my ear encouraging me and letting me squeeze their arms as hard as I needed. During one contraction I felt the urge to push or bear down.  Pushing made the pain more tolerable. I used that feeling to help me get through several more contractions. I thought I had been in the pool for many hours. Afterward I asked my sister how long it was and she said it was only about 30 minutes. My midwife asked me to out of the pool because she said she needed to monitor the baby’s heart rate between each contraction. She wanted me in a different position so that it might help the baby’s heart rate improve. From what I understood at the time, the heart rate was low, and not recovering very well between each contraction. I found out later that my midwife had been monitoring this complication for a while and was getting concerned.

When I got out if the pool at 9pm I was dilated 8.5 centimeters. The contractions were coming very fast as I moved into transition. I was pushing through these because that felt the best. My midwife said the pushing might help get me more dilated. I moved into several different positions to see which one was best for the baby’s heart rate. Finally, I was fully dilated. Hands and knees seemed to be the best position for the baby and I was ready to push my baby out. The midwife said she could see the baby’s head. I pushed as hard as I could and I didn’t feel the baby descending. It was difficult for me to recover between contractions because I was exerting so much energy pushing. I was trying to use vocalizations to help with the pushing and I was wearing out.  And then, I heard my sister call 911. My midwife had asked her to call for an ambulance because we needed to transfer to the hospital. I was devastated. Everyone else was still optimistic, and my midwife told me what was happening. The baby’s heart rate had been too low for too long. She suggested that maybe I could still push the baby out while we waited for EMS. She said she could see the head, and that gave me a burst of energy. I pushed so hard because I wanted that baby out. I had a feeling that if I got transferred to the hospital then it was possible that a c-section was in my future. I was determined to not let that happen. I kept pushing with every ounce of energy I had. When I was inspecting my body after the birth I noticed broken capillaries on my hands, arms, and face, and a broken blood vessel in my eye. These were probably due to the strain of pushing. My midwife even tried to help get the baby down the birth canal with her hands, but that proved to be very painful and it didn’t work. Several contractions later the baby was still not coming out, and the paramedics had arrived.

I was exhausted and I felt so defeated. Why couldn’t I push my baby out? What was wrong with me?  Was I really bad at pushing? Was I weak? They gave me some oxygen that would help me catch my breath and help improve the baby’s heart rate. I had oxygen for the rest of my labor. Since hands and knees was the best position for the baby, that is how I was transferred to the hospital. They had to get some clothes on me, which felt awful. A t-shirt was found and a sheet was draped over my naked lower half. Moving to the stretcher was difficult because we were in my very small bedroom. The EMS crew was very capable of course. They told me exactly where to put my hands and I was strapped in. I was told later on that there were about 15 EMS personnel in my house. They sent two ambulances and a fire truck. As my neighbors looked on, I was wheeled down my driveway with my butt in the air, still trying to push my baby out. I didn’t see any of what was going on because I was face down in the stretcher. My husband had to ride in the front seat of the ambulance because they needed two paramedics in the back to get me ready to arrive at the hospital. I decided I was going to push the baby out in the ambulance and I continued to push. They put an IV in my arm despite my protests. The ride to the hospital seemed to take a really long time. Everyone from my house arrived there before us. And, I found out later, the ambulance driver did not know how to get to the hospital from my house. It was now close to 10pm. I still didn’t have a baby after over an hour of pushing.  

Once in the labor and delivery room I started begging for relief from the painful, fruitless contractions. I still wanted a vaginal delivery and I had no idea how long it was going to take. I asked for an epidural. Of course, that process takes some time and I was convinced they were trying to keep the pain meds away from me. I was told I could keep pushing while we waited for the doctor and anesthesiologist but I knew nothing was happening. The oxygen was helping and the baby’s heart rate had improved a little bit, but was still in the range of concern. I finally got the epidural, and the doctor checked my cervix. I had a feeling he was going to say, “I think we should do a c-section,” and I braced myself for the news. However, he told me that I had plenty of room to have a vaginal delivery, but the baby’s head position was making it difficult for it to descend the birth canal. The was coming out forehead first and at an atypical angle.

You can see the purple bruise and the head shape.

The epidural seemed to calm me down The pain and pressure were never eliminated. I was able to move out of the hands and knees position. The hope was that with the pain meds my body would relax and pushing might be easier. After resting, and giving the baby a chance to rest and get its heart rate regulated (it was still low), I started pushing again. My midwife, her assistant, my doula, and my husband were still with me and continued to coach me through each contraction. We got the mirror and I used it help me focus while pushing. Lying on my side, and holding my knees to my chest, I pushed while looking at the baby’s head. The baby was still not making progress, and I had been at 10 centimeters and pushing on and off for 3 hours. The doctor suggested a vacuum extraction. I asked to go a few more rounds of contractions before using the vacuum, and he agreed. After more pushing there was still no progress. I got into position to use the vacuum. The doctor warned me that I would still have to do most of the work to get the baby out, but he would use the vacuum to help the baby get through the birth canal. Despite the epidural, the vacuum extraction hurt more than any of the contractions. I pushed once, and the head was out, and I pushed again and the baby was out completely. The doctor counted, “1, 2, 3,” the number of times the umbilical cord was wrapped around the baby’s neck. I was eager to get my hands on my baby and the doctor wanted to make sure everything was okay before handing him to me. There was an on-call pediatrician in the room, just in case the baby needed some assistance.  I suppose they were called because of the baby’s low heart rate. Everything looked fine and the doctor handed him to me. His head looked like an eggplant because of the vacuum and there was a skid mark down his nose. Within the hour the swelling on his head had gone down completely, and the huge purple bruise faded after two weeks. At 8 pounds 6 ounces, my baby was born at 12:18am.

I had a  2nd degree tear in my perineum. The doctor said this was due to the vacuum assisted delivery. He latched on to my breast easily, and by the time we left the hospital two morning later my milk was coming in. I am very grateful my midwife made the decision to go to the hospital. At the time I was sad I did not get my perfect home birth. As we all know, things don’t always go as planned. The support of my doula, midwife, and husband are immeasurable. The greatest lesson I learned from this birth experience is we all need compassionate support during labor and delivery. I was so defeated and my birth team kept my spirits from getting too dark. And, in the end, we had a healthy baby.

The next morning.

 
Amelia Mattocks