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Tuesday
Jul122005

UC Story - written to me

UC birth of an 11-pounder – told to me, then sent to me, and I was requested to keep her anonymous. But, this is her story in her voice.

My second child was a planned unassisted homebirth. How that came about is a long story for another day.

I was fearful tearing at the scar tissue from my horribly managed first birth, and my preparations for this birth included stretching my vaginal tissues with an Epi-No (basically an inflatable sex toy) and taking evening primrose oil and occasionally using it in my vagina as well.

The night before his birthday, I noticed some painless contractions with pressure. This was a new one for me. I was at 41+0. With my first baby, I started labor at 41+2 after feeling first contractions at 41+1. So I was expecting the baby any day.

I slept in the front bedroom (I'd had a bad cold that week and had moved in there) from about 10pm to 4am, a pretty good stretch for pregnant me. I turned on the light and read the fifth Harry Potter book and was just about to turn off the light again just before 5am, when I heard my fifteen month old daughter wake up in the family bedroom. I switched beds.

I had nursed my daughter for about 20 minutes when I felt a RIP SPASM RIP SPASM with a sensation like the baby jerkily pushing on the top and bottom of my uterus at once. I thought I should go listen to the baby with my fetoscope and make sure he sounds good. I unlatched my daughter and started to sit up to get out of bed but when I felt the fluid rushing outward. I took a leap out of the bed to save the sheets from getting wet.

I said to my husband, "I think my waters broke." Of course there was no "thinking" about it. They were ruptured. He said, "Are you sure? What does that mean?" I said, "That the baby will be born today."

I didn't have to wait for contractions; one started as I walked to the bathroom to check the fluid color (I'd been wearing a pre-fold in my underwear to contain any urine leaking from my coughing fits that week and there was nothing to clean up). It was nice and clear. The contractions were those lovely easy cramp ones that just barely hurt. I was very relieved because although I was prepared to wait for weeks if I PROM'd and had no signs of infection, I was just glad that for my first UC things were going the way people "like" them to.

I went into the kitchen to make breakfast for my daughter and my husband got up and tried to adjust both to an early rise time and to the news that he wouldn't be going to work. I carried a chux pad or a towel around with me to sit on. My daughter and I ate eggs and cheese as I eagerly anticipated calling my mom with the news. My aunt and Mom were both staying in town and would come over most days around 8:30 or 9am to help with the baby and the house and be with me. I wanted to call late enough that they would get all their sleep, but early enough that my aunt could plan a day without Mom, because she (my aunt) was not to attend the birth.

I called Mom about 7am. I loved hearing myself say that the baby was coming today.

I listened to the baby once, and his tones were good.

Mom came about 8am and I was leaning on the counter during contractions humming, but not because I needed to yet. I was just having fun.

My husband asked when the baby would come and I guessed by five. He packed up our daughter and went off for a day of fun, starting with breakfast out and then the petting zoo.

I hung out on the counters chatting with Mom until a little after nine, when I decided to get into my hot tub in the borning room I'd set up. This was my private space where no one could enter without permission. Within a few minutes, I was weeping with emotion and singing and dancing in a continuous activity that hit some peaks during the contractions but continued through each space between contractions with the same -- quality. I was singing open, open, open and weeping with the intensity of my ... pleasure might be the right word. Pleasure at being in labor, pleasure at being a mother, pleasure at being alone. They didn't hurt very much yet so I don't want you to get the wrong impression when I describe it as intense. It was emotionally intense.

Suddenly at about 10:45 or 11am, the emotional intensity turned off and I suddenly felt very normal and very sleepy-tired. My contractions, not close together before second stage, seemed to space out a bit more at the same time and I wondered if I could lie down and take a nap. But I hesitated so long each time between contractions that by the time I tried to approach the steps out of the tub, another contraction would hit. So I was tired, somewhat bored and not sure what I wanted to do right then.

Suddenly my mom walks in kind of cheery talking about some phone call she had with her sister. I said, "You aren't supposed to do that! But right now I want you to stay and talk to me." I considered my options and ordered a cheese sandwich and a peanut butter sandwich. She brought them back to add to my poolside table stock of weak Gatorade, water, liquid calcium, cal-mag, vitamin C and Rice Krispy treats (I'm sure there's something I am leaving out from what I consumed in labor). I ate a couple of quarter sandwiches and accepted some neck and back massage while still in the hot tub. It was still not emotional and I was laboring by moving to the other side of the tub when a contraction was going to start and doing my water-labor move -- holding the side of the hot tub and shaking myself forwards and backwards while moaning.

I moan really well and I never suffer while I'm moaning. If it hurts more, I just moan louder and it covers up the pain.

I still wanted a nap and asked if we could move to the living room. I had two identical nightgowns for laboring, one "wet" and one dry. I changed out of my tub gown into my land gown and to my pleasure was able to manage contractions lying on my side on the couch. I dozed in between contractions while Mom massaged my feet and legs.

Before I forget, I want to tell you about these contractions. In my first labor, my contractions felt like a bell curve. In this labor, they were always (once they had clear sensation) 0-90 in five seconds and almost immediately started sloooowly backing off so that they hurt for about I'd guess 30-40 seconds. They were VERY short and well spaced. About an hour before he was born, I think my mom said they were 4-5 minutes apart by my soundings. She thought he wouldn't be born until about 6pm.

While I was lying on the couch, my husband and daughter came home briefly to change clothes before heading out to a restaurant for lunch. Dad put a blanket over our child’s head so she wouldn't see me and ask for Mama, and they rushed in and out.

I spent maybe forty-five minutes on the couch and then decided to go to the bathroom. That was very difficult. My contractions got close together when I tried to do that. It was a challenge contracting in the bathroom and I decided I wanted to get back in my tub. I was going as fast as I can but still had two more contractions before I could climb back into the hot tub. I think Mom was with me to help me change back to the wet nightgown but then she scrammed upon request.

I was back into that emotional place again for about another hour or hour and a half. Contractions were more intense at this point, but in neither of my labors have I ever had “transition.” I don’t throw up, I don’t shake, I don’t say I can’t do this. But during this time, I was only singing and dancing and weeping with joy in between contractions. When a contraction came, I threw myself at the side of the hot tub and just started sounding with all my might so that I didn't have to hurt.

And suddenly, for about a half hour, I left that emotional space like I had late morning and was just kind of bored and laboring. I was quiet, looking around almost bored in between contractions and sounding like crazy during them. And during the contractions, I very distinctly felt my pelvis being pulled open evenly in all directions. Hmmm, I thought. Very interesting. No pressure though. I can't feel the baby pushing on anything. I had been checking myself toward the end but just felt head and a really stretchy, painless womb opening for maybe the last half-hour or hour of labor. I couldn't figure out how to get to the posterior side of the head to feel actual dilation so I just contented myself with exploring my baby and my body.

This is such a minor thing, I left it out of the first draft. Probably five or six contractions before my body started pushing the baby out, I had this thought and feeling "I need to poop and pee and that will make me feel better and that will make the birth easier." It is the same feeling I had the night before labor where I felt right before bed: if I could just empty my bladder I wouldn't feel this pressure with the Braxton-Hicks contractions. But during labor, it wasn’t pressure. Well it might have been, but I would never have said “oh I feel all this pressure” like some women do in their births. It was very subtle. I tried peeing and pooping in the hot tub after a contraction but nothing would come out. I was momentarily frustrated and scared because after the first birth (where I pushed for hours on a full bladder), I wanted to have an empty bladder to birth past, but then I decided not to worry about it and I did not notice it after that. (I think if I had said to a typical midwife, I have to poop, and she had said, “Oh, that's the urge to push. Start pushing,” that it would have been a damaging wrong thing. I also think (now bear in mind this is my first experience of actually giving birth and actually getting to feel a real, full first and second stage), that if I am lucky enough to birth a third time, that since I don't go through transition, maybe that will be my signal to prepare for birthing -- when I get this sense that I want to be empty.)

Then I felt the warning for the next contraction and grabbed the side and started to sound and rock when THE BABY'S HEAD CROWNED. I was like, “OOOOOOAAAAAAAAAAHHHHHHHHHHH MOM GET IN HERE! I WANT YOU HERE NOW!!!!” My vagina went from being empty to being completely full of head in about ten seconds. She hustled in and I told her the baby was coming and, “GET OVER HERE AND HOLD ME UP.” So she kneeled by the hot tub and I put my arms around her body and she held my shoulders and that's how I birthed the head over five or six contractions. The contractions were still short but much closer together and all I could do was hold on and holler. When I hollered, the head moved down. When the contractions were dying down enough for me to stop hollering, the head stopped moving. His head was way outside my "body" before he was clear of my perineum. It was so wonderful because it felt SO right and I knew I was not going to be harmed. I didn't have to push; my body would do that for me in this very mysterious, perfect way.

On the fifth or sixth pushing contraction, his head finally cleared my skin. I would say this was about 10 or 12 minutes into second stage, since these short pushing contractions were frequent. I recall being able to have short conversations with Mom between contractions, four or five statements apiece, before he would start moving down again. I remember as his head was being born, there was no pain in between contractions as long as I did not move. At one point between contractions during the birth of the head, Mom asked me if we could move a foot to the left so that she could kneel on the steps (that's right, she was being forced to stand during contractions to support me where we were) and I tried, but cried out, “stop!” because it hurt. But with my body suspended in water and not moving, I was completely comfortable in between contractions.

I told Mom that the head was out. My eyes were closed and I backed away from Mom a bit and sat there in the water. I reached down to feel his head, located the landmarks of his face and felt him, willing him to start rotating. He stayed face backwards, not moving, not moving ... slowly he started rotating. He made the turn toward my right thigh. Good baby. I went to feel around his neck for curiosity's sake. My intention ahead of time was to leave nuchal cords alone.

Two loops of cord ... um, I don't feel a pulse here. It never occurred to me that that would be the situation so it affected me differently than it will in a third birth. I didn't like it.

He had moved once during his head birthing, so I wasn't too scared but I wasn't happy and decided to try to do something. I believe I referred to this in the early postpartum period as my attempt at Stupid Midwife Tricks and I still do not know if I was doing the prudent thing; being benign but ineffective; or causing some type of harm or some combination of these. I just want a nice pink baby next birth.

Or purple, that will suit me too.

Just not white.

I do think that my activities probably slowed down the arrival of the next contraction. But since in my experience, delayed contractions hit harder, maybe that worked out for the best. He was a big baby.

The first thing I did was tell Mom what my concern was and turn around and present her with my behind so that she could reach him underwater and I asked her to unloop the cord from around his neck. I was thinking at the time that this was "doing something" and maybe the cord would get moved and whatever was causing it not to pulse would be somehow changed.

She unlooped his cord and I felt it. Still limp. I decided to get out of the hot tub.

This is what I remember after I got out of the hot tub. I have thought about it, and I think this is complete and ordered. I remember getting on hands and knees facing the wall, and asking Mom to suction him with the bulb to see if that would make him start breathing while he was still inside me. I knew this was not a shoulder dystocia, but I remembered reading that sometimes when shoulders are sticky the baby will (not often, but sometimes) be able to start breathing on the perineum, which takes the time pressure off. And what I wanted was breathing baby. He made some mews of irritation probably right before losing consciousness. (This was really a bad experience for him and when he loses it entirely, I sometimes think he is remembering When the Bad Thing Happened). I hoped that meant he could breathe. I asked her if he was pinking up. She said no.

I got up and went to the side of the hot tub. I remember holding on to the edge of the hot tub and doing some squatting and kind of shaking myself to see if he would fall out. I remember trying to push in this position, but I had no idea how to push consciously and I felt I was not being effective and was just going to hurt myself.

I went back to hands and knees and asked Mom to see if she could -- (remember I am not a midwife) but what I was remembering is pictures on TV of babies with their heads out and the doctor has his hands all over the baby and is kind of pulling down on the baby's head with the mom supine and the baby slides out. I didn't want his head pulled on but I asked Mom if she could put pressure on one of the shoulders to see if he would come out. She went in and said, "I can hook an armpit." I said "Give it a little pull" knowing my mom never forces anything (from early childhood, my parents constantly told me not to force things or I would break them). She did and I said, “OW STOP.” I think this is where I got my skin split because I don't remember anything hurting the wrong way but this, if you know what I mean.I think I decided I would climb some steps and see if he would fall out. I am not sure where I got the idea that he might fall out, but I was ever hopeful.

I was just about to walk through the doorway to leave the borning room when the next contraction hit -- I suddenly dropped forward to the floor without thinking and out he came. Mom said something cheery like "There it is!!!"

I was slightly lower than hands and knees I think, but it happened very fast. I turned around, scooped him up off the floor and started talking to him and rubbing his back and patting him. I had him stretched out lengthwise on the air mattress on the floor of the borning room. I was kneeling next to him on the floor thinking these thoughts: Oh dear, he is white and floppy. Oh my, he's big. Oh, look at that penis. Oh, look at my beautiful baby. I kept rubbing him briskly and I said, "Come on little boy." Mom said, "It's a boy?" surprised because she thought he would be a girl.

He stayed white and floppy with his eyes closed during this vigorous rubbing, turning over on my arm, and more rubbing and talking. I ended up giving him three lungfulls of air before he started screaming and turning bright pink.

The placenta detached while I was kneeling there because that's where the blood puddle was. I didn't notice this at the time because I was so busy working on him.

I moved to the air mattress and sat there holding him and rubbing him and trying to comfort him with the breast. I took off my nightgown, naked for the first time but not worried about being powerless now. I held him to my bare chest. He kept screaming. I said I wanted to get into the tub and see if he would relax if I put him back in the warm water. Mom helped me and then I asked her to go call my husband.

I heard her from the kitchen saying, “Congratulations you have a son!” She came back into the borning room and said, “He is three minutes away. They are just leaving the playground.”

My son was born at 3:20 pm

He kept on crying in the hot tub.

My husband came in holding our daughter and trying to get his bearings. The baby was still screaming. He said I should get out so the baby wouldn't get cold. I didn't want to argue about how 90% of his body was in 94-degree water, so I got out and got on the air mattress and covered us with the comforter.

The baby still wouldn't nurse and I wanted to use nursing to help with third stage. So I asked my daughter to sit next to us on my left side and nurse. She hesitated and then nursed for a minute just staring at her brother crying hysterically in my right arm and then burst into tears. The squalling baby was getting to be too much for me, too.

Our daughter went back to Daddy and I lay on my left side and tried to nurse him again. I asked mom for my cell phone and left a message (complete with screaming baby in the background) with an understanding midwife. She didn't answer so I tried another friend. She didn't answer so I hung up and just stared helplessly at my distressed baby and cuddled him and talked to him and tried to nurse him and willed him to please stop crying. I picked up the phone and called the midwife again. She answered this time and I told her he was born and probably a little about it, but mostly, "He won't stop crying! Why is he crying?" She said something like, “Sometimes their collarbones might break on the way out. Be careful with his arms.” And hearing "bone" "break" I said, "OK YOU CAN COME OVER NOW." (She'd said earlier in the week, "I don't have to wait three days or something to come see that baby, do I? I'm special, right?” And I said, “I don't know. Maybe, maybe not.”) And she chuckled and said she would be by later in the evening after registering her team for lacrosse league. So we chatted a bit and rung off. I told her he was a big baby.

Shortly after that, my husband made another you-should comment (I can't remember what it was, but I think it had to do with warmth or cleaning off blood or “why aren't you nursing him?” or something like that in an effort to be helpful in the face of a naked unassisted birthed wife and screaming baby) and I said, “You all need to leave me alone because I still have to birth the placenta without bleeding to death. I am going to go into the bathroom where we can sit under the heater in the ceiling.” So I did. And it was lovely in there and after maybe a total of three crampy postpartum contractions, I had an urge to lean over from a standing position and release the placenta, which fell painlessly to the floor.

He stopped crying around this point and was alert for five or six more hours, but really wouldn't nurse.I called Mom in and asked her to hold the baby so I could take a bath and clean off. She sat on the closed toilet holding the baby in a towel with the placenta lying there on the floor. I hopped into the bathtub and took a quick bath. Within a few minutes, the baby and I and the placenta in a bowl were snuggled into bed. Mom brought me the rest of the labor sandwiches, relatives were called, my daughter came up on the bed to snuggle and nurse, and my aunt came over from the bed and breakfast.

I cut the cord at 3 hours under pressure from the family. At about five or six hours, I replaced the cord floss with a clamp because blood was leaking onto his blanket. When I clamped it (still four or so inches down the cord) in front of the floss, being very careful not to pull the cord, he SCREAMED. I won't be interfering with the cord on my next baby unless I have to for his safety until it is hard and dry.

I was getting tired and wanting to go to bed so I called the midwife to find out if she was really coming. She said she was on the road on the way so we stayed up a bit longer. Mom and my aunt left for their room, taking comfort in knowing that the midwife would be stopping by as an extra layer of "everything's good."

I was in the big rocker cuddling a sleeping newborn when my husband let the midwife in. She came up, eager to see him and I said, "He's a big baby." She asked to hold him and I handed him over. She said, “oh my, he is big ... oh my.” She put him in the sling for her scale and tried to lift it while sitting on the couch, but she couldn't. She had to stand up. Eleven pounds even.

You know, I almost always wanted to do for myself in this pregnancy. But at the very end of the pregnancy, I wished for (but never pursued) someone to give me a prenatal because I was tired of looking after myself. And after my son was born, I just wanted to partially hand over responsibility for things to someone else so I could just hold my baby and not feel guilty for not scrutinizing him. I wanted someone else to put a diaper on him and dress him. The midwife gave him a barebones newborn exam (he did not have a broken clavicle) and visited for a while before leaving us to sleep for the first time as a family of four.

After being woken and unwrapped and then dressed, my son was mad enough to do a first good nursing. But as I realized over the next two days, there were no really good nursings. He was tongue tied so eventually I gave up on stretching it and convinced the midwife to notch it for me when he was about 10 days old while I held him in place (harder on her than on me). His nursing improved immensely after that and he started catch up gaining.

And that is the story of the birth of my son.

I ask:

Why wasn’t your husband there?

Birthing woman answers:

He wasn't there because his role in the birth was to mainly be helping with my daughter while my mother mainly helped me. For example, we discussed in a transfer my mother going with me while he went separately with our daughter, gathered up diaper bag and so forth and then gone and done insurance stuff while my mom stayed with me. It wasn't planned ahead of time that he wouldn't be in the house, but since I had gone into labor first thing in the morning, on a beautiful day, it seemed natural and appropriate that they go off together since my mom was there for me. I found it very peaceful to have the house empty. Had I given birth a few hours later, he might very well have been home. But when we discussed things ahead of time, he did not want to be in the room (our first birth was a rape, which I’m sure affected him in this matter). And I had a strong rule that I was not to be outnumbered at any time while birthing.

I ask:

Why didn’t your husband dress the baby instead of the midwife?

Birthing woman answers:

My husband will hold tiny babies, change babies diapers and clothes as asked, and so forth but he feels very unsuited to handle them until six months or so and before that he is afraid of their fragility or having them cry and he can't help. I left my son swaddled naked until my midwife friend got there, since she was going to look him over for me and I didn’t want him to have to dress, undress and dress again; and since I was not feeling like dressing him it seemed natural to impose upon her to do it. I did want him in a diaper before I took him to bed.

I ask:

Why don’t you consider this a shoulder dystocia? In your description, by every indication and sign you describe, it was a shoulder dystocia.

Mom answers:

This is a hard question for me. You’re the first to call it that, though I’m sure not the last. He was not turtling, he did rotate and when I talk about waiting for rotation, well he didn’t rotate immediately but he was a watched pot. I’ve just counted one-onethousand, two-onethousand … with my eyes closed. Remembering. Five to seven seconds passed before he started rotating. It only felt like forever. Time passed SO SLOWLY, and he birthed easily and in reasonable amount of time after the head was born. 90 seconds, two minutes? It felt like a long time between the head and body contractions, but I was moving quickly between those activities so it was just my perception.

I did not ever feel resistance on my pubic bone. The head didn’t come fast but I was holding back power while birthing the head. When I did get a contraction he slipped right out immediately without any voluntary pushing on my part. My sense, during the period when I was trying to get him out without a contraction, was that I had time to try to do it without hurting myself. He was mewing when Mom suctioned him, for example. There was a point where I would have started pushing like crazy with her pulling and I was almost there because I was running out of ideas and time seemed to be passing slowly; stairs were my last idea. But it didn’t come to that.

If I birth again, I don’t know. I’m still working out lessons from this birth.

You know, after writing all of the above I did a web search on “sticky shoulders” and found this:

Excerpted from http://192.220.73.80/archives/shoulderDystocia.html#Difference
At midwife deliveries (which amount for about 80% of births in my unit ) the shoulders are delivered by maternal effort and force of contractions in most cases. Typically there is a lull in maternal effort and uterine contractions after delivery of the head. The next contraction typically doesn't come for 90 -120 seconds. By the 60 sec definition almost all of these normal deliveries would be defined as shoulder dystocia, this must mean the definition is inappropriate.

Note from me:

“Turtling” is when the head is born outward and then is sort of sucked back inside… a classic sign of shoulder dystocia.

A short note from mom says:

I would like to make sure the message is heard about how amazing my mother is.

Note from me

I have heard wonderful things about her mother’s presence and presence of mind during the birth a number of times. I know this birthing mom was very blessed to have her mother available to nurture and witness her own daughter during her daughter’s child’s birthing.

Reader Comments (3)

omgoodness! I commented below your post about the UC mom whose baby died that I thought I knew your friend on the East coast, and in fact I do! What a small world...and I guess the homebirthing community is even smaller.

July 12, 2005 | Unregistered Commenterkayla

An amazing birth story! I'm so pleased you got to birth the way you wanted this time. Thanks for sharing with MKP.

July 14, 2005 | Unregistered CommenterAmy/Mum Of Two

What a wonderful story-I really enjoyed your emotional descriptions-you captured the feelings of birth so well. The borning room sounds lovely.

July 14, 2005 | Unregistered CommenterKelly

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