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Tuesday
Nov222011

Guest Post: Max's Birth Story

A dear NetFriend sent me her amazing hospital natural birth story and since she doesn't have a blog and I do, I get to share it with everyone here. Lucky us!

Slightly edited for clarity (with permission) and names and initials have been changed for anonymity.

"Oh, He Doesn't Do That"

As is the case with so many birth stories, the events that defined Max’s story were set in motion months before his actual birth day. Max was my 9th baby. My eighth pregnancy had been awful. Hyperemesis Gravidarum requiring a PICC line, Zofran pump and home health care. A week-long stay in Telemetry, Gestational Hypertension and a week-long NICU stay. When all was said and done, I ended up with a healthy child but it was a long, miserable, emotionally and physically difficult pregnancy and recovery. One of my greatest supports had been my OB. Through it all, he was there. He was actively engaged the whole pregnancy, always listening, always advocating, always caring. So obviously, the first thing I did when I got the second line in Oct 2009 was call his office for an ASAP appointment.

“Hello, I need a new OB appt with Dr. M.”

“I’m sorry, he’s deployed. Can I make you an appointment with another one of our physicians?”

“DEPLOYED! WHAT? He can’t be!! I need him!”

I immediately felt awful. Here was my doc, deployed to Iraq and I was being all selfish and worried about myself. I felt even worse when I found out later that his son was also deployed. His poor wife!

I asked for an appointment with one of his partners, a woman who is lauded as the grand dame of natural childbirth in our area. She used to do home births, will go to extremes to avoid C-sections. Doulas and patients love her. I didn’t. It was apparent by 10 weeks that we weren’t going to be able to work together. I saw her long enough to get prescriptions to manage the nausea and vomiting, which thankfully wasn’t Hyperemesis this time around, and then went looking for another provider.

I went to interview the one group of hospital-based CNM’s in our area. I was hoping I would like them, and I did. Unfortunately, they didn’t like my history. After the three of them discussed it, they decided that I was too high risk and out of their scope of practice. I was devastated. I was so looking forward to midwifery care again. They referred me to an OB in their practice.

“He’s a great guy. You’ll love him.” I was told. At this point I was 16 weeks and just wanted to get a care provider and move on. I felt totally defeated. Whatever, fine, I’ll make an appt. I diddled around on the Internet and found a few reviews of him, they were glowing but there didn’t seem to be a lot of ‘noise’ about him. Not like the woman OB I had left behind. Her name is everywhere.

I started seeing Dr. K for what ended up being a very vanilla pregnancy. He was a great guy and we did get along very well. We talked a lot about my kids, his grandkids, politics, etc. After all, this wasn’t my first rodeo; I didn’t have a lot of questions and didn’t need a whole lot of patient education. Sometimes we talked ‘shop’. Me, being a woman who has immersed herself, literally, as a mother of 9 and figuratively, as a doula, childbirth educator and parenting educator in birth for almost 18 years and him as an OB. The NIH VBAC Conference occurred during that pregnancy and we talked about that and quite frequently about other birth issues.

I never sat down with him and listed what I wanted/didn’t want/believed in/liked etc. We never did a birth plan. We just chatted. He would leave me with little gems like, “A lot of my colleagues practice fear-based medicine, not evidence-based medicine.” And, “I just try and respect the mother.” And, “You know what you are doing. You listen to your body. I listen to you.” This let me know that for the most part we were on the same page.

Not surprisingly, my blood pressure started creeping up in the late second trimester. Nothing scary, just worth watching and it quietly crept up and up week after week. I reached 38 weeks and started getting nervous. I had endured one pre-eclampsia labor with magnesium sulfate and really, really didn’t want to do it again. With that baby I had gone from fine to extremely sick over a weekend. I knew how fast I could go downhill. Dr K wasn’t concerned but respected the fact that I was. At my request, he checked my cervix and I was 2-3/80%/0 station. He agreed to induce me that Friday which would be 38w5d. It took some finagling but I was ready.

Friday morning I showed up at the hospital. He hadn’t booked me in; I was supposed to come in and tell them my blood pressure (BP) was up and get a preeclampsia work up and then he’d just decide to keep me and have the baby.

Well, my admitting BP was 160 (something) over 90 (something) and didn’t come down much with rest. Oh, and I do not have white coat hypertension. The whole pregnancy my BP had been lower at office visits than at home. Think the 8 kids at home could have had anything to do with that? The bogus preeclampsia workup became a necessary one. I think Dr. K was a little surprised to be honest. My blood work and urine was fine, so no Magnesium Sulfate but I was definitely having this baby.

I was admitted, installed in a labor and delivery room and my GBS antibiotics started. During the initial admission questions I told them I was allergic to iodine so make sure he doesn’t use a betadine perineal wash. I was told, “Oh, you have Dr. K, he doesn’t do perineal washes.”

Dh (Dear Husband) and I just hung out and watched a little TV, talked and walked the halls for a few hours. They wanted two full doses of the antibiotics in before (they did) Artificial Rupture of Membranes; we had at least a solid 4 hours of waiting. We got to the hospital at 9am; they didn’t start the antibiotics until noon. So far it was a long boring day. Finally, at 4:30 the two doses were in and here comes Dr. K to break my water. He breaks it, watches the baby on the monitor for a minute and then says he’ll see me later and leaves. The nurse takes me off the monitor (??) and tells me to go do whatever I want and let her know if I start contracting. I was a little confused.

“Oh, continuous monitoring? He doesn’t do that.”

I was confused, but thrilled. I popped in my ear buds, grabbed my Dh and we start walking. It’s a small hospital and L&D is just a little “L” but I walked and walked. Back and forth. Grooving to my music. I don’t do Enya and waterfalls when I am in labor. I prefer to sing and dance. I was pacing to “Dancing Queen.” Unfortunately it wasn’t really working.

I’d pass the nurses’ station and my nurse would raise her eyebrows questioningly and I’d shake my head. Finally after an hour passed I decided it was time to really get down to business. I was determined to not be up all night and equally determined not to need Pitocin.

I sent Dh to dinner and asked for a birth ball. It was about 5:30pm. I turned on my ‘baby’ music, sentimental country and Michael Bublé-type songs, something to get the emotions going. I sat on the birth ball and did some nipple stimulation. Within 15 minutes I had two good contractions and that was all she wrote. I was in active labor.

I was pacing around the labor room when Dh got back. A, my nurse, put me on the monitor for 15 minutes, which showed a happy baby and active pattern and then I was off again.  For a little while I walked the halls, this time much slower, stopping to put my head on the wall and sway my hips during contractions. The nurses would give me thumbs up as I went by. It wasn’t long though before I knew I was done being out where people could watch me and I retreated to my room. I was starting to get vocal during contractions. During one good one as I stood next to the bed in a shallow squat, I growled through the contraction, A turns to me and says “Really cooking now, huh?” …smiles and keeps charting. That was the extent of her interference in my labor dance. Sometime during this Dr. K was called to tell I was in active labor. He came, watched me for a minute, asked if he could check me, I was a 6 and he said, “Great! Call me when it is time to have a baby!” 

The biggest disruption in my labor was shift change. I had had one nurse since I walked in the door at 9am and now, when things were getting pretty intense they changed. BOO! Luckily, I was blessed with another great nurse, D. I was back on the monitors for a few minutes. After a couple contractions I told D, “I need to get up and off the monitors!” She asked, “Just a few more minutes?” and I said “NO.” She said, “OK” and I’m off the monitors, never to be on them again. I mention to her that I don’t use leg rests and prefer to support my own legs etc. She said “Oh, Dr. K? He doesn’t like the bed broken down.” I also mention that I’d like the lights on low. “Oh, he doesn’t use the spotlight.” I am now very active and starting my litany of “I want to be done. I’m done. I don’t want to do this anymore. Can I just be done?” which I know means baby is coming soon but I always seem to forget that when I am in the thick of it.

I don’t stay in the same position for more than one contraction. I am most comfortable (as comfortable as one can be minutes before birth) standing next to the bed. I started to push during the peak of contractions and it was obvious baby was coming soon. D looked at me and asked, “Time to get Dr. K?” and I told her yes, it’s time, baby is coming soon. We had 15-30 minutes based on prior births. She calmly left to go get the doc. It’s just me and my husband and we’re both very quiet and concentrating. I have another contraction standing next to the bed and let loose with the classic, “uuuuuuuUUUUUNNNNGGGGGGHHHhhhhhhh!” The door burst open and in bustled a different nurse with her eyes wide and scared looking and snapping on gloves. “I HAVE TO CHECK YOU!!!” By this time the contraction is over, I’m out of labor land and look at her and say, “No you don’t. I’m fine. D went to get Dr. K.” “But I do!! I have to check you!” “No you don’t,” and this went on for a couple minutes until D walks into the room. “B, what are you doing in here?” “She sounded like she was pushing!!” “I know, I told you I was getting Dr. K, everything is fine!” and she bustled the hysterical nurse out the door. Dr K comes in a few minutes later with a smile, watches a contraction, says something quietly about it being almost time and then he just kind of stands off to the side. I’m still flipping all over the place, hands and knees, over the back of the bed, squatting. I request the squat bar and Dr. K tells some random nurse, “Get her the squat bar!” At this I look up through my ponytail hanging in my face. He is standing there, not gowned and masked, not wearing the HazMat suit all the other doctors do. He is wearing his scrubs, as always, and a pair of gloves, standing with his hands clasped, his hip kicked out and his glasses on his nose. Just watching.

Finally, I end up kind of perched on my left hip, with my arms wrapped around my husband’s waist and my face buried in his stomach and, “Here he comes!!” Dr. K continues to just stand there. My husband leans over and says, “When she says that, she means it.” Because my litany of labor whining has never stopped and the “Here he comes!” came out in the middle of “I can’t do this.” And “Am I done yet?” Dr. K springs into action!! Which for him means he twitches his finger at the nurse to push the delivery table closer and he walks over to the side of the bed the baby was going to land on. He bends over, tells me, “The baby is right. here.” With the next contraction I give my first real push and the head is out. Being the busy body I am, I direct Dr. K to “Get the shoulder, get the shoulder!” and I feel a hand gently push my knee back just a bit more, then I feel one shoulder go, then the other and then my little boy sliding quickly out. There he is!! Dr. K looks at him for a couple seconds and immediately gives him to me. The nurses throw a couple of warmed blankets over us and everything is quite calm. Max is extremely alert, breathing beautifully and absolutely covered in vernix. We had to wipe some off his eyes just so he could open them.

Dh and I wonder over our little guy. Dr. K monitors the cord, the unclamped cord and B (the hysterical nurse) listens to Max’s heart/lungs while he hangs out on me. After a few minutes, Max starts squeaking a bit and B starts rubbing him and saying “Good baby, give us a cry.” Dr K. pipes up, “Leave him be. He’s pink, breathing, his cord is still pulsing. He doesn’t need to cry.”

You have to understand that Dr. K has a very quiet calm voice but you would have thought he yelled at her. She backed off completely, like back to the baby warmer. Max started nursing, the cord stopped pulsing, the placenta came. It was all good. My perineum was intact, but I was bleeding. Too much. B was back listening to Max and when she looked down at Dr. K and D working on my lower half her eyes got all big again. That woman needs to learn to control her facial expressions. I knew I was hemorrhaging, it’s par for the course for me. I had told D that she should have Pit hung and ready and she had listened so there was already a bag of Pit ready to go. They hooked it up and opened it up wide and were doing all the usual things. I may have received other meds too, I don’t recall, I was pretty wrapped up in my baby. The bleeding slowed to acceptable levels although I would end up anemic and it would take me weeks to catch up. Max was over an hour old when they asked if they could take him to the warmer, examine and weigh him. A little while later we went to the Postpartum floor and had a nice uneventful postpartum stay.

It was a lovely birth. I never felt that I was being “managed” or controlled. Despite my laundry list of risk factors I was never treated like a ticking time bomb which has often been the vibe in previous births. The memory of it really helped carry me through the following week when Max was admitted to the Children’s Hospital for what turned out to be viral meningitis that he caught from a couple of his siblings. In big kids it was a fever and headache that was easily controlled with a dose of Motrin and going to bed early one night. In a 4-day old it ended in a three day hospital stay on a monitored unit.

#10 is on his/her way. I pray we get a similar experience and outcome in April 2012. I know that with Dr. K in my corner I at least have a fighting chance.

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Reader Comments (10)

I frequently read your blog, but this is my first comment ;) just wanted to thank you and your net friend for sharing this, I tend not to read hospital birth stories, because I feel so strongly for mom's in labor and their stories often bring me to tears in empathy with them...this story also brought me to tears, but joyful tears! What an awesome birth and I am so happy to hear about such a respectful OB who genuinely cared about mom and trusted her and her ability to birth! Warmed my heart!

November 22, 2011 | Unregistered CommenterRachel

I think the elephant in the post is this - why so many kids? What are the risks inherent in that many children? Why does this author choose to have more children after having pregnancies with complications? Doctor sounds great, parents sound educated, and with as little judgment as possible, curious to learn about their life choices.

November 22, 2011 | Unregistered Commenterdanielle

Ok, can I just order up a birth like that for my second go-round? Seriously, that sounds like the best doc pretty much ever. (And one awesome, prepared mama, too!)

November 22, 2011 | Unregistered CommenterAmelia

Danielle-
We are Catholic and as such are open to life. This does not mean that we are trying to have as many children as possible (ie quiver full) just that when my husband and I come together it is not only for mutual love, comfort, pleasure etc...but also for the possible the transmission of life. We may not 'try' to get pregnant but we do nothing to frustrate it either. I have had difficult pregnancies, yes, but not all and I have had very easy pregnancies follow very difficult ones. I've never been advised not to get pregnant again. If that day comes, my husband and I manage.

November 22, 2011 | Unregistered Commentermax's mom

What a beautiful birth story!!! Thank you so much for sharing.

And now for the question on everyone's mind: how do we clone this doctor? :)

November 22, 2011 | Unregistered CommenterKristen

Reading through this (such fun!), I've been reflecting on my own labor/delivery (almost 6 months ago, wow!). As a completely non-medical professional, I am trying to educate myself for the next time around and to support any of my girlfriends if and when they have babies...so I was wondering, can you say anything about causes/risk/avoidance things for periurethral tears (or is it just the same as normal tearing?)

Thanks!

November 27, 2011 | Unregistered CommenterElleB

Periurethral tears happen when the baby's head is pressing more upwards (towards the urethra) than downwards. If mom is on hands and knees, the pressure can be that "upward" direction. When birth is left to its own pushing devices, women tend to do okay, but the baby's head position, whether there are nuchal hands or not... combined with mom's position all can affect where she will tear.

Having women push as they want to, not directed, slow and stop... slow and stop... slow and stop... these are ways to allow the perineum to stretch gently.

The most common periurethral tears I've seen are when the provider is doing maneuvers with the baby's head... Ritgen comes readily to mind... that causes the upwards tears.

My own Zack (who was Sarah when he had the baby) had a periurethral tear, also from the Ritgen maneuver along with a two push second stage with a giant headed child. He had to keep the catheter in for a week and got a raging UTI that kept him in the hospital several days longer than he should have been there. It was a complete drag -caused totally by a bitch OB.

November 27, 2011 | Registered CommenterNavelgazing Midwife

What a gorgeous story!! Thank you so much for sharing, I really really love it when good hospital stories are out there for people to read! (mostly because where I live, we are underserved by midwives and so many women who would hire one simply can't get one, and therefore are birthing in hospital with docs)
I would be curious to know if the OB is old? He sounds very much like how some docs I know attend births - and they are all over 60.

November 28, 2011 | Unregistered CommenterNicole

I am adding this blog to my blog roll. :)

Such a beautiful story. If all hospital births had the chance of being like this (and they should) I would not be so scared of them in relation to birth. I had an out-of-hospital birth with my son...and the story was similar in tone and joy. So nice that a hospital and non-hospital story can share that.

Thank you to the mother for sharing!

November 28, 2011 | Unregistered CommenterSamantha

What a soothing story! I am just reading up on everything birth right now in prep for my first natural childbirth (second birth) and I loved this story. I was thinking it would be nice to share the name of the DR so others can see him! Either way, I loved the last picture of that cute little baby right after birth. His eyes are wide open and he is fully alert! I hope to have that kind of experience.

April 15, 2012 | Unregistered CommenterRebecca C.

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