Sunday, July 12, 2009

Lily’s Home Water Birth, or, The Timely UPS Man

This blog, by nature, would be incomplete without my own birth story. So without further ado:


Prelude: Even though I was only 36 weeks along, plus change, and I figured I had a couple of weeks after I stopped working to go into my OCD nesting frenzy, I had the overpowering urge to clean the floor late Sunday night. I swept and then mopped, and was about to start cleaning the bathroom but talked myself out of it, since I was so exhausted. It was late, and after all, there was plenty of time.

*****

Monday morning. I woke up at 10, since I had a late start and planned to do some errands before my first client arrived at the office at 2 – including picking up the home birth certificate form from the town hall. As I lumbered from my bedroom into the kitchen, I trickled some fluid onto the floor. I was aghast for a second, thinking I had peed, of course, but my bladder wasn’t full & I just, well, didn’t feel like I had peed. The little puddle had a slightly red tinge to it, but since it wasn’t the huge gush we’ve come to expect thanks to movies and TV, I wasn’t sure. I went straight to the bathroom, where I promptly passed my lovely mucous plug.

It was supposed to be my last week of work – I had just worked on Saturday and then ran around doing some errands on Sunday, including attending my home birth support meeting. The day after next, Wednesday, was supposed to be my 36 week home visit, where my midwives, Nancy and Gengi, were to come to my house for the first time, meet with my labor support team, and talk extensively about how to prepare the house, the tub, and the birth kit – not to mention myself. The following week I had set aside to clean, pick up gear, organize, and then after that, I was planning to just rest and relax for my final week or two – and Aaron would come out to Massachusetts at some point in there in order to be ready. At some point soon, by birth kit would arrive (my midwives, like most, have each client order their own birth kit – a package of standard supplies like gloves and Chux pads and peri bottles, which can be customized for the preferences of both midwife and client), as well as the La Bassine birthing pool, both of which had been ordered one week ago.

(Note: there were some discrepancies with my due date – one method put me at 36, and one put me between 37 and 38. But since ‘first babies tend to be late’, we all figured we should err on that side. Right? Also, it had only been two weeks since the placenta previa that had cast a shadow over my pregnancy was finally confirmed to have ‘migrated’ out of the way, at a 34 week ultrasound – after getting many more ultrasounds throughout than I would have liked. I had feared that I wouldn’t even be able to deliver vaginally, let alone at home, and had been on pelvic rest and forbidden exercise from week 18 on. But this is another story.)

So, mucous plug, check. Some fluid, check. I knew that losing the plug can sometimes mean the onset of labor, but I also knew women who lost theirs and then walked around for another week or two. Unsure whether this was going to drag on, I called Nancy & left her a message – little did I know that she had had a late birth on Saturday and was then laid up with a migraine on Sunday. I texted Aaron and told him not to freak out just yet, I wasn’t sure what was happening – but to be on alert. Then I logged into my message boards with a cup of half-caf, as per my usual morning routine, and contemplated what to do. As I hung out there, I started to notice some contractions, but they were very, VERY mild and quite far apart – well over 10 minutes. These were different from the Braxton Hicks ‘toning’ contractions I’d been having for months; in fact, about a week prior I had had just a few of these ‘real’ yet mild contractions one evening. About three or four – and then they stopped. I thought nothing more of it at the time.

Eventually I decided to get on with at least some of my day. I went to the town hall, but the right person wasn’t there yet – I was told to come back at 1. I got gas & went home until then, and made a few more calls. I let my office know that, while I wasn’t sure I was in labor, I “might not feel up to coming in,” so maaaaaaaaybe we should cancel my clients. Just to be on the safe side. Then I called the birth kit company – it turns out there had been glitches with my order even though I placed it a week ago. I wasn’t sure what we were going to do if this was really labor.

My friend Patty was going to be my doula, so I called her next. I had JUST talked to her yesterday to remind her about the home birth visit scheduled for Wednesday, and she had gotten back into town that very day from a weekend away. She was at work, but promised to stay by her phone and would plan to try and leave early, just in case. I decided to go ahead and page Nancy on her labor or emergency-only beeper.

My contractions were becoming a little more real, but nothing too intense; I could still talk through them. I started to keep track of the times, and they were indeed becoming more frequent. Since I hadn’t heard back from Nancy yet, I called Gengi, her (very experienced) apprentice. She answered right away, and listened to everything that had transpired. She would try and get ahold of Nancy, and would plan to come up and check me early in the afternoon if I continued to progress, bringing some paper strips to test my fluid & see if it was really amniotic fluid (I was still skeptical). Gengi also said she would stop by Nancy’s and put together a birth kit for me, since I didn’t have mine yet. I thought sadly of my puny bathtub and what a poor substitute it would be for the luxurious-looking 100 gallon birthing pool.

I had a little lunch, noticing that I was now needing to stop what I was doing as each one hit. Nothing major, just wanted to stop and breathe a little. I decided I’d better go back to the town hall, this time having contractions all the way (fortunately, it was only a 3 or 4 minute drive). The town clerk was there this time, and was rather alarmed by the whole situation (though perfectly friendly).

I got my paperwork and had her explain it as best she could – she had never had to hand one of these out before. I leaned on the counter and put my head down with each contraction. When I got back home, I walked to mailbox & it was becoming clear that the contractions were getting stronger – I had to come to a dead stop halfway up the driveway. I also noticed that I was still occasionally trickling fluid. And then, I cleaned. I know, I should have rested, but I also really needed to do the bare minimum, at least. Now I knew why I’d had that totally uncharacteristic late night urge!

I let Patty know that this was maybe starting to take off, and I was worried about all the things I hadn’t yet picked up that were on the checklist in addition to the birth kit itself, like receiving blankets and towels. She made a list and headed out to the store on her way to my house. Finally I tried to relax in the gliding rocking chair as I waited for Gengi and Patty (Nancy had been reached, but needed to rest up for a while if this was it – in true midwifery fashion; the baby always arrives when it’s least convenient for the midwife.) I kept writing down time of contractions - I think by now they were about 5 or 6 minutes apart – and tried to remember to keep drinking water. I continued texting with Aaron, as I had been all morning. He had finally wrested himself free from clients and was on his way.

Suddenly there came a knock on the door. I didn’t think either Gengi or Patty would be here just yet. Lo and behold, there stood a UPS worker, holding the box that contained my inflatable birthing pool. I stammered at him in surprise that I just couldn’t believe he was here, that I was actually in labor that very moment! He seemed unimpressed.

I set the box on the counter and went back to the rocking chair – and this is where things start to get a little blurry. Gengi arrived about 10 minutes later, in an orange sweatshirt and jeans, and immediately went into action setting things up, saying we’d do an exam soon. Though Gengi was still an apprentice (apprenticeships take years and years), she was also very experienced, professionally and personally: her first baby was a cesarean due to a breech baby, her second was a vaginal birth in a hospital, and the last three were all born at home. I adored her as much as Nancy and felt totally safe in their hands. She also happened to be LDS, which made me feel oddly connected to my biological – and Mormon - side of the family, was very slim and calm in bearing, and devoted to homeopathy as well as midwifery. Patty arrived soon after that, and she started pitching in to help Gengi with the setup, including assembling the pool.

It was right about here that I started having to vocalize, not just breathe. I was surprised by this, as I’m not normally a vocalizing kind of person. Always been shy about it in yoga classes when invited to “sound it out” and such. But this was completely unavoidable. Gengi kept reminding me kindly to keep my tones low – not as in quiet, but as in deep (naturally, I could be as loud as I wanted). I continued to hang out mostly in the rocking chair. The few times I went to the bathroom and had a contraction on the toilet, I noticed that it seemed to intensify.

Okay, time for the moment of truth already. It was time to do the exam. We went into the bedroom and she checked me there. She pulled out her gloved hand, index finger straight and middle finger cocked at an angle, and regarded her fingers thoughtfully. My jaw just about hit the floor when she said “I’d say you’re at about six.” Up until that point, irrational as it is, I hadn’t REALLY believed I was in real labor; that this was really happening. It couldn’t be! I had 3 or even 4 more weeks! I didn’t have all her diapers, or our changing table, or the breast pump – and I never, ever got to take any time off! Wow. WOW.

And, of course, this is where things really took off. I decided to take a shower, since I hadn’t done so yet and it would be a while before the tub was ready. It was less than relaxing - I had several contractions in the shower, and Gengi had to come in and go over a questionnaire with me while I was in there (important stuff that was normally covered during – you guessed it – the 36 week home birth visit, like whether we would do the PKU, the eyedrops, vitamin K, etc.). I kept having to pause and rest my head against my arm on the shower wall.

When I was done, I got into some comfy pajamas and decided to experiment with being on my hands and knees, since the glider wasn’t doing it for me anymore. It was okay, but not great. I thought I’d try lying down, just to see. I made it through exactly one contraction that way. It was completely unacceptable. Actually, correction: it was FUCKING EXCRUCIATING. (Forgive me, but there's just no other way to accurately capture that sensation. It wasn't just the pain itself, which seriously went up to 11, but the sense of becoming completely unmoored and unhinged and just plain lost in the despair of it.) I rolled over on my side to see if that improved things, and it was the tiniest bit better, but still sucked unbelievably. I would have lost my mind if I had been forced to lie in a bed. Back on my hands and knees I went.

Meanwhile, Gengi and Patty did a record-breaking job of getting the birthing tub inflated (blowing into it – no fancy electric pump or even a manual bicycle-style one) and filled, including the eventuality of running out of hot water from our tiny tank (it was 29 gallons – and the tub was 100). They then had to constantly boil all the biggest pots I had on the stove - all the while things were getting more intense with me, of course. Fortunately, being me, I got a lotta pots.

Patty took over all communications, as I was losing the ability to speak. I had made a list of all the key people who needed to be called. Aaron checked in regularly, driving frantically, the poor guy. He could hear me bellowing and braying in the background with each call.

At some point my cat made herself scarce.

Gengi and Patty took turns coming in to the bedroom to deal with me. The hands and knees just was not working as well after a while – after some uncomfortable experimentation, I finally found the one thing that worked for me. I had to sit upright on the edge of the bed with my feet pushing into the floor (the mattress and box spring were right on the floor). I needed back support, so I tried having Patty sit behind me, back to back.

This was the ticket. With each contraction I pushed my feet into the ground and leaned hard in to Patty, clutching her hand for dear life, and moaned to the heavens. Sometimes she would moan along with me, trying to help keep my tones low. Gengi came in and did soothing strokes down my legs and gave me gentle, empowering words from time to time. She also used the Doppler to listen to the heart rate periodically, though I never again had another internal exam. This went on for a while, until the rest of my water broke, and this time it was the full flood. I yelled for Gengi.

Digression: Somewhere along the way, I completely lost all verbal ability. “Those lights are starting to bother me. Can we turn them down, or maybe off?” in my mind became “Lights. Too bright,” out loud. “Oh, wow, Gengi, come here - I just felt a lot of fluid gushing with that last contraction,” became “Fluid! Fluid!” Communicating in proper sentences took so much effort – it would have been indescribably awful to have to try and discuss anything. I still had the fully articulated thoughts, but there was a total disconnect between my thoughts and expressing them. It was amazing just how withdrawn into myself I became. My Self, I suppose.

Back to the flood: Gengi came in and started to fiddle around with the amnio testing strips, then scrapped it since it was obvious that this is what it was, and she could see that it was clear. She helped me out of my pants and moved me to a birthing stool after I had more gushes of fluid, both of which took some effort. This is where it started to hurt more in between contractions – there was no longer a break between, as there had been all along, just a slight easing off. I heard Gengi make a call to Nancy. “I think you should come now.”

This grew and grew in intensity. I had always been the most afraid of the moment of crowning, of the dreaded “ring of fire” sensation, as it has been described. I had never truly grokked that my vagina would have to stretch just as much on the TOP as it did on the bottom. This has been described as the “bowling ball” sensation, which is quite accurate – that combination of pressure and stretching was almost constant. Someone in my homebirth meeting the day before who had recently given birth talked about the discomfort of rectal pressure, and this was the case with me. (The final stretch of the perineum that I had so feared was really nothing. Not that it felt good, exactly, but after three hours of Lily descending through my vagina, it barely registered.) Soon after this, I had a few contractions with double peaks & hit transition. Dear GOD.

Nancy arrived right around 8:00, just as the pool was finally, ready set up in the center of the kitchen (my support team had been working on it this whole time, along with the rest of the setup – blankets wrapped in paper and ready to go in the preheated oven, instruments and gloves set up, a cornucopia of herbs, some methergine and pitocin (purely in the case of postpartum hemorrhaging, never for inducing or augmenting labor,), suctioning and resuscitation equipment at the ready. At last, with much help, I climbed in and yanked off my shirt in one motion, and immediately clung to the side, resting my head on the cushioned edge.

So began the next three hours.

Nancy knelt by the pool, despite wearing her trademark long denim skirt and sassy boots, and held one hand while Patty usually held the other, between giving me sips of Recharge, the natural version of Gatorade. That’s another thing I thought was so clichéd, along with vocalizing: would I really want to hold someone’s hand? What’s the big deal? Would it make that much of a difference? Yes, yes it would. Patty told me later that at one point I was squeezing so hard she thought her hand might really fracture, but that she somehow managed to detach herself from it, like, “Hmm, I think my hand might actually break. How interesting.” (She said nothing about it at the time, bless her.) We tried a cool cloth on my forehead, as the water was warmer than I’d have liked (but needed to be a certain temperature minimum to deliver underwater safely), but it just felt annoying. I slapped it away.

On we went. Gengi continued to check the heart tones periodically (the Doppler could go underwater, no problem). After a while I started to doubt myself. I actually did have an urge to push earlier, but I didn’t trust it. It seemed too early, and I had heard stories of women pushing before they were complete and creating swelling, or being similarly counterproductive when a ‘lip’ was there. As a way of encouraging my progress, they got me to reach in and touch my baby’s head. I had a hard time believing that this was really, truly my baby, right there, being touched by the outside world for the first time. I think even said “Are you sure?” out loud – though I also remember reasoning silently, “Well, what else would have hair INSIDE my vagina?”

I felt a little more confident then, but found that it hurt too much – and was too scary - to actively push during contractions (some women feel relief in this, but others don’t – everyone is different). I preferred and felt it best/right for me to actively push as each contraction ended, and focused on allowing my uterus to push in its own, which it normally really does, if you can get out of its way – the 'expulsion' or ‘fetal ejection reflex’.

Where was Aaron? Still just driving as fast as he could, poor guy. He continued to check in with Patty. I managed to summon the words to tell her that when he arrived, to make sure to do so as quietly and calmly as possible. Any disturbance would be jarring to me, I knew. Introducing a foreign person who wasn’t yet part of the vibe, for lack of a better word, would have been upsetting, no matter how much I wanted him there, and I needed to have Patty run interference, since I didn’t feel capable of communicating that myself. Even necessary conversations between the ‘team’ members was a bit irritating to me, unavoidable as it was; they all did intuitively keep such conversations to a minimum and cast their voices low, wise women that they are.

Once in the pool, I only changed positions twice – starting as above, leaning forward on the side, then turning over to lean back on it. At one point Nancy tried to convince me to get out and try pushing on the toilet, but I just knew deep down, and from the previous contractions I had on the toilet, that it would be too intense for me. I needed to take my time, no matter how exhausting, so Nancy let it go. Thank God I had providers who trusted me and my body. They were like guardians, Nancy behind me holding my hand, Gengi across from me watching with the big flashlight (I needed the lights very dim). Patty circled around as needed.

Reassuring me, Nancy pointed out, when I had a moment of whimpering, that almost every woman cries a bit during childbirth at some point. I remember asking Gengi to pray for me a little – not out loud, just to silently say a small prayer, and she nodded.They said very little during this final stretch, for which I was deeply grateful, save for intermittently checking in with the Doppler and telling me softly that I was fine, and what a wonderful thing I was doing, giving my baby such a gentle birth. I’ll always have that impressed upon me, the memory of these strong and mostly silent, endlessly patient women standing guard, protecting me, encouraging me without prodding, graciously witnessing.

At last, I felt that it was time to commit, that this would just have to be it, and I really gave in to it, finally. It was like a crossing over. I pushed more actively. I ended up in leaning back position. “Curl your body around your baby,” Nancy encouraged, and doing so (tilting my pelvis, still buoyed by the water, and contracting my torso, almost as if doing a crunch) really progressed things. I remember feeling some movement from inside the birth canal around this time, knowing she was shifting position, trying to help find her way out. What a new sensation that was . . .

After such a long pushing phase (though I also had a sense of time suspension – I went into labor determined NOT to watch the clock obsessively, once it was safe to stop timing contractions, anyway, and it worked; once I was in hard labor it didn’t even occur to me to check the clock), the finale happened so quickly. I wonder if anyone else perceives it that way. The final moments were just – boom! boom! boom!

I heard Gengi’s voice: “Crowning . . . the head is out (here Gengi quickly checked for a nuchal cord, and then I reached down in disbelief to touch her too) . . . Reach down for your baby!” And there she was, clasped to my chest. 11:03 pm.

I always thought I would be sobbing with joy – and the joy was there, but I was also just in complete and total shock. “Oh! Baby! Samily (our prenatal name for the mystery fetus, a combination of 'Sam' and 'Lily')!!! Baby baby baby,” was all I could muster at first – you can hear this in the short, murky videos Patty took of the final moments. She lifted up her head for a split second with wide open eyes, looking as surprised as I was, and as pink as can be. Love at first sight. Who cares if it’s a cliché?

They had me keep her in the warm water for a minute for warmth (head out, of course) as they put her hat on, checked her breathing (she let out rough and healthy little squawky cries) and got the blankets ready. I asked tremulously if it was a boy or a girl, and Nancy told me to take a look & find out. I lifted her teeny leg – surprise! I had been so sure it was a boy. “Wow, look at that!” Nancy said. I had to check twice to be sure. It’s such a small detail, but I’m glad I got to discover that for myself, that no one announced this to me. “Do we have a name?” Nancy asked, and I told her “Lily.”

After a nice rest, enamored with this little creature, it was time for the placenta. Nancy kinda had to talk me into it, as it seemed so anticlimactic, and all I wanted to do was hold and gaze at Lily, massaging the vernix into her skin, but on this one matter they were pretty firm. So Lily was handed to Patty and with a few pushes - not painful, if a little uncomfortable - and the gentlest possible cord guidance, it was done. We put it in a silver mixing bowl since we wanted to wait for Aaron to cut the cord (and wanted to let the cord stop pulsing on its own, anyway, to make sure she got as much healthy blood and stem cells as possible). Nancy showed me the cord and had me feel its pulse, knowing I was interested in such details.

They then had me get out of the tub, reluctant as I was; there had been a little more bleeding than usual, and they needed to assess it properly and couldn’t do so in the water. Out I went, and my babymoon continued (the bleeding was fine; notable, but within the range of safe). I offered the breast, but she didn’t root, and seemed uninterested, so we decided not to push it (this, of course, setting the stage for our much larger trial by fire, though we didn’t see it at the time). I managed a snack, and finally, Aaron arrived to cut the cord, and took her in his arms for the first time.

Eventually I was examined on my bed, and there was no tearing to speak of save for a tiny bit on the inside, nothing justifying any stitching or anything. Nancy helped me waddle gingerly to the bathroom and made sure I was able to pee and generally tidied me up, showing me how to use the peri bottle and the cool comfrey-witch hazel compresses Gengi had prepared and stored in the freezer. I slipped into the mesh underpants that I’d wear for the next few weeks and put on a huge mattress-like pad (I wouldn’t notice the freakish ‘roids until the next day). While I was gone, Aaron carefully dressed Lily in her first wee onesie and teeny little fitted diaper.

They examined her thoroughly at about 2 am, noting her extreme molding, her long delicate French manicure, the tie on her upper lip (the posterior tongue tie wouldn’t be diagnosed until later), and her overall great health. The team stayed until a little after three, though they’d be back the next evening and then several more times again. Exhausted as I was, I hardly slept that night, curled cozily next to her in our bed. I just could not stop staring at her.

The most amazing day of my life, in general. About 13 hours, official start to finish. I am still in awe that my body did this – it really did. It knew exactly what to do. As one woman put it in the film “The Business of Being Born”: “I knew I couldn’t do it - and then I did it. I hit that wall, and I scaled it.”

*****

Epilogue: My birth kit arrived two days later.


11 comments:

  1. Fabulous birth!!! She's such an adorable girl! Thank you for sharing your birth story :-)

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  2. Lovely story! What a great birth story.

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  3. What an amazing birth story! That is the type of birth I wish I had had.

    Too funny that your birth kit arrived two days later. Figures.

    I'm following you now too, by the way. : )

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  4. Hey there Morgan!

    I can totally understand your feelings on that, yet through your experiences, you've found such a wonderful way to help other women. What a truly inspiring, positive example you are!

    Cheers!

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  5. I had a similar experience except that the midwife had just come for a home visit at 35 weeks on Monday and at 35.5 weeks I went into labor (I also had dating discrepancies, but I KNOW what day I became pregnant because my husband was out of town all the month before!) and the birth tub came the day AFTER my son was born.

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  6. Ha! Close but no aquadoula. Dang. Hope you were able to at least soak in a nice tub or kill the hot water tank with a lengthy shower!

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  7. My eyes are just welling up with tears of joy!!
    What a truly Joyous Birthday !!

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  8. I LOVED reading your birth story! Nancy was also my midwife.. (she linked it on her facebook) I'm always excited to hear about other women who chose this route for birth. :) You truly have a gift with writing!

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