Monday, November 12, 2012

Guest post: A doula's path through pregnancy/birth (Part 3: Birth story)

This is the last in my friend and fellow doula Chris's series on a doula's path through pregnancy and birth. Other installments are here:
Intro: All you have to do is be there
Part 1: Prenatal care and education
Part 2: Preparation - physical, mental, and more

I think this is a pretty amazing birth story - Chris has suggested, and I am planning, to do a follow-up post on one of the topics raised in it. Thanks again to Chris for working so hard on this series to share her experiences and knowledge, and thanks to Kevin for writing the birth story in such detail! They are great friends, great parents, and they have just about the cutest baby in the world.


Part 3:  The Birth

In the days right after you give birth, you think you will never forget a minute of it.  It turns out that’s not the case, and life with a baby (and probably some really awesome hormonal processes specially designed to help you forget pain) makes things get fuzzy very quickly.  Luckily, in the days following delivery while I was dozing with the baby, my awesome rock star amazing birth partner and husband Kevin took the time to write down a very detailed description of the birth from his perspective.  This is the birth story according to Kevin, with my notes added in italics.  

Christine’s contractions started about dinner time on the 9th of May, one day after the baby’s estimated due date.  Her parents were in town and came to the house to make us dinner.  It’s funny now to think back on the unintentional good decisions we made that evening.  For example, I decided to take a nap and then took a short run to perk up before eating a large pasta dinner.  I guess I subconsciously knew I would be working hard that night, so I needed to be in top form.  (I also enjoyed a glass of good whiskey and reflected on our pre-kid years).  

Around 8:45PM, after her parents had left, Christine told me she had a strong contraction that felt different from the Braxton-Hicks contractions she’d been having since the week before.  She hopped in the shower to see if that would soothe them.  When it didn’t, we figured this was the real deal.  Nothing left to do but wait patiently at the house until contractions were 4 minutes apart, drive calmly to the hospital, and push out a baby....easy, right?

By 10:45PM Christine was having trouble focusing on things other than the contractions.  We were halfway through a movie when she decided to move into the bedroom where it was quieter and she could concentrate on breathing through contractions.  She told me I could keep watching, but I knew better than that. My main focus for the previous 40+ weeks was supporting her, and I wasn’t about to start labor by neglecting her to finish watching a movie.

I remember that conversation.  I also remember walking away and thinking “I really should have told him to turn off the TV and just come with me.”  I also remember that he almost immediately showed up in the bedroom with his Birth Partner Game Face on.    

So we moved into the bedroom and started timing and working through the contractions.  Around 11:30PM we called Caroline, our doula, and asked her to come to the house.  While we were waiting for Caroline, I started packing the car.  I also made the mistake of making Chris laugh just before a contraction started. The combination of the two was pretty intense, and she started to 1) laugh harder, 2) cry, 3) shake, and 4) cry some more.  That freaked me out a little; I was worried she was progressing faster than we thought (that she had somehow hit transition) and that we would have to hurry to the hospital or call an ambulance.  Turns out, laughing and contracting were just not a good combination!

I was surprised at what happened when I laughed and contracted (I read a lot of Ina May Gaskin, and she is all about laughing through contractions).  But for me, when I laughed, everything just got all out of control.  I guess I needed to focus on the matter at hand.

Caroline arrived a bit before midnight and confirmed that we were definitely in labor.  We didn’t actually need her to confirm it for us, but it made Christine feel better to know we weren’t overreacting. (I was very concerned about going to the hospital too early).  By now the contractions were about 4 minutes apart, and Christine was working hard to get through them.  She was doing a great job focusing on her breathing and staying relaxed through and between contractions.  Then everything slowed down.  It was a little before 1am when the contractions spread out--first to 8 minutes apart (I thought I had missed one), then a couple at 10 minutes apart.  I figured maybe the baby was just being considerate and wanted us to sleep (I pictured us going to the hospital at 9am alert and totally well rested).  But she faked us out!  I had just made up the futon for Caroline when Christine’s contractions started again--right back to 4 minutes apart.  They were a little stronger, so Caroline suggested the tub.  Caroline helped Christine get situated and started pouring water over her belly as I packed up the last few items for the hospital.  This was the moment I remember thinking “I’m so glad we got a doula.”  

From 2:10 to 2:30 the contractions were 3 minutes apart and gaining intensity, so we decided to go to the hospital.  We hopped in the car and took what seemed like the slowest possible route to the hospital.  I felt particularly bad about the route selection while we were crossing through a neighborhood that had speed humps.  Of course, the contractions seemed to find every bump in the road.  Anyways, we got to the hospital at 3am and entered through the ER.  Caroline and Christine headed up to Labor & Delivery while I grabbed the ridiculous number of bags we packed and took care of check-in at the ER registration desk.  By the time I got up to L&D Christine and Caroline were getting settled into Room 3, which has a tub and is HUGE.  That’s why the staff call it the “Taj Mahal”.  It also faces east, which made for a beautiful ambience in the room a little later that morning.  

It’s important to note what DIDN’T happen when we checked into the hospital.  No IV was inserted, and I was not permanently connected to the monitors. (They hooked me up for the first 15 minutes or so, and after that only monitored me intermittently).  I didn’t have to get into a hospital gown, and there was no prohibition on food or drink.  No one made dreadful statements about my last chance to get an epidural or IV pain meds.  Full credit goes to the midwifery practice for making sure their practices truly support normal and unmedicated birth.  

Our arrival at the hospital marked the point where the labor turned into as much (or more) of a psychological challenge as physical.  When I got up to L&D, The charge nurse escorted me back to the room and asked for the details of the labor so far, and we showed her a copy of the birth plan.  Tanya, the midwife on call, came in to check Christine’s dilation and assess her progress.  We had met Tanya at an earlier office visit and really liked her.  She confirmed with Christine that at her last checkup (at 40 weeks on the dot), her cervix had been 90% effaced and in a good forward position but not dilated at all.  We had all assumed that 8 hours of contractions would have opened her cervix to at least 2-3 cm (Christine was hoping for more like 4-5).  Tanya could see the frequency of contractions from the monitors, and I think she expected to find Christine to be pretty far along as well.  That turned out not to be the case--Christine’s cervix was still completely closed.  

I’d been consistently impressed by the midwives during the pregnancy, so it’s hard to identify one caregiver who stands apart--but I think Tanya (and later Diana) were exactly the people we needed for this delivery.  Tanya immediately recognized that something was off with the progression of labor.  The contractions should have been producing more progress.  It turns out that about 10 years ago, Christine had cryotherapy to remove abnormal cells on her cervix that turned up on a pap smear.  Evidently the procedure left scar tissue on her cervix that was now preventing it from opening.  I’m still impressed that Tanya had the presence of mind at 4am to ask about this right off the bat.  She said she could clear the scar tissue with her fingers, and Christine gave the go-ahead to do so.  It was pretty intense and looked pretty painful, but Christine dilated to 2cm immediately, and her water also broke.  

This is where everything got very fuzzy.  I remember saying “yes, do it” when Tanya asked about clearing the scar tissue. She did it while I was in the middle of a contraction, and I remember intense pain and a gush that turned out to be my bag of waters breaking.  After that, labor felt like something I could just barely hang onto instead of something I was in control of.  It was almost like starting a second, entirely different labor.  It took a while to wrap my head around what had happened and what was happening, and I remember feeling very needy--like I really truly needed everybody in that room to be constantly telling me I was doing well and that it was going to be OK.  That emotion wasn’t one I had anticipated.    

The baby was now on the way for real, but Christine was pretty deflated to find out she wasn’t further along.  It’s also important to point out that dilating 2cm instantly is physically demanding.  Christine’s body was playing catch-up at this point, and the contractions became much more intense.  She got shaky and started shivering, and asked to get in the tub.  

We had talked through a lot of labor and delivery scenarios to try to be prepared for a curveball--what if labor stalls?  What if we needed an emergency c-section? What if the baby needs to go to the NICU? But this situation never crossed our minds.  In some ways it was harder than some of the other things we discussed.  Rather than presenting us with a concrete decision, it placed Christine on a different trajectory, and she dilated faster and delivered sooner than she would have if she had truly been at 0cm at 3am.  The labor went from feeling manageable for Chris to feeling like something that she could just barely hang on for.  

The contractions before and after my water broke were very different.  Before, I could stay in control and breathe through even the most intense contractions.  After, I remember feeling pushed to my absolute limit with every contraction.  I lost all composure and really needed Kevin and Caroline to help me refocus after each one.  I remember feeling restless or almost trapped, and having that back-of-the-throat almost-scream feeling.  They would talk me down and get me to breathe and relax and make productive noises.  

I’ve been able to provide pretty good detail so far, but things sort of blend together from this point onwards.  Christine stayed in the tub, and Caroline and I stayed next to her and did our best to help through contractions.  I would remind her to breathe and relax, and Caroline would provide comfort measures (hand holding, water on the belly).  Unfortunately, the hospital only has regular-sized bathtubs, so it’s difficult to get the belly all the way in the water.  Christine had great support, but she was doing all the work.  One thing I told her repeatedly was “No one is more prepared for this than you”.  It’s true--she was as ready physically and mentally as any first-time mom could be.  Some women would have caved under the mental strain and physical pain, but my wife is TOUGH.

One thing that didn’t cross my mind during labor but I have thought about a lot since then is the fact that, in accordance with our birth plan, no one offered me pain medication.  In the end, I think this made all the difference in my ability to have an unmedicated birth. I really believe that if someone had asked me when I was at about 7 or 8cm if I wanted an epidural, I would have said yes in a heartbeat.  But as it was, I was so far into the labor zone that I didn’t even think about medication.  And since no one brought it up, I just kept doing what I was doing and it turned out exactly how I hoped.  When I was a doula, I don’t think I understood how important the not-asking was.  I thought “Well, if they ask, you just say no.”  Now I get it.  Having an unmedicated birth depends on a lot more than just previous intention and willpower.  

One thing Chris needed a lot of was reassurance.  She really needed to hear “Yes, you’re making progress” and “Yes, it’s moving quickly”.  She asked Tanya to check her a couple of times while she was in the tub, and each time she had made progress.  By the time she was dilated to 6cm, I was standing in the tub to help support her through contractions and to give counterpressure.  Before I knew it we were at 8cm, we had moved back to the bed, the delivery instruments had been prepared, and we all thought Chris would be pushing at any moment.  It was about 6:30am, and Christine had dilated from 0-8cm in 3 and a half hours.  Christine’s mom arrived sometime around then, and I remember Chris asking “Mama, how did you do this twice?”.

We tried a number of positions on the bed, but Chris was most comfortable on her knees, leaning over the back of the bed (which we had put in the full-upright position).  By 7AM she was having a LOT of back pain.  I was applying counterpressure with each contraction, and LeeAnn (our nurse) and Caroline were pushing against Christine’s hips.  I was also massaging her back with raquetballs between contractions (I had lots of tricks in my gypsy bags).  It took almost two hours to get through transition, which was slower than anticipated given how fast she had gotten to 8cm.  The baby had been anterior all through the pregnancy and had been low in the pelvis for some time.  It seemed unlikley she would have rotated to a posterior position during labor, but the nurses and midwives started to wonder about it since things had slowed down and Chris was having so much back labor.  I was concerned because she had worked so hard all night long, and I was worried she would start to run out of steam if pushing was very difficult.  When she finally began to push (around 8AM), it wasn’t an overwhelming need.  She would push a little but then stop halfway through contractions, saying it was all she could do.  

I had lost all concept of time by this point.  I remember being upright on the bed, leaning over the back and moving my hips constantly.  I couldn’t stop it, even though I was so tired.  I remember Caroline standing by the head of the bed feeding me Craisins between contractions.  I remember that eventually, the pain never went away, even when I wasn’t contracting.  I think I said “the baby is going to come out of my back”.  And I remember that I did not like to push.  I never had an overwhelming urge, and when I did push, I could only do it for about half of a contraction.  After that the pain was too much and I just had to breathe.  But nobody was rushing me or counting or telling me to hold my breath and push for longer.  They let me figure it out on my own.

Around this time the midwives had a shift change, and Tanya handed the reins to Diana and Angela.  (Since Diana is new to the practice, Angela was there to back her up).  I took shift change as an opportunity to consider our options for getting Christine some rest or pain relief.  We wanted an unmedicated birth, and the nurses and midwives were great about not offering epidurals or other meds after the very first time (I think they were required to have her do the pain scale and confirm that she was aware of medical pain management options upon admission). But I wanted to talk through our options in case we didn’t get things moving again, or if Christine turned out to be too exhausted to push.  Christine was SO tired, and I thought that if we got something to cut the pain, she may be able to rest a bit and come back at it with more energy.  

Pushing was a struggle at first.  Christine had a hard time finding a comfortable pushing position on the bed and was struggling to activate the right muscles.  LeeAnn reminded her that you need the same muscles you use for a bowel movement, which may have been what got Chris thinking about the toilet, so we headed to the bathroom.

I also remember LeeAnn being really hands on.  She took my hands and looked right in my eyes and told me that I had to find the exact place where it hurt the most and push straight into it, even though that felt like the last thing I’d ever want to do.  And she was right.  She pretty much taught me to push.  

While Christine labored in the bathroom, I stepped out into the hall with several of the midwives to discuss what might come next if Christine was too tired to push.  We were all hoping no intervention would be necessary, but it seemed wise to have the discussion before things got urgent.  There was talk of Nubain to cut the pain and provide some time to rest, asking the MD on call to scrub in and see if the baby's head could be rotated into a more favorable position, and vacuum extraction as a last resort.  (I remember having the feeling that if I didn't start making some good progress with the pushing, people were going to start suggesting things that I didn't want to hear.  I was already pushing, but at that point I started pushing like never before.)  While we were talking, Diana (the new midwife on call) was with Christine while she pushed.  When she joined us in the hall, I asked for her thoughts on how things were going.  She replied that she wasn't sure whether the baby was posterior or not, but she felt like Christine was making progress with pushing and the best thing to do would be to give her some more time to work before suggesting anything else.  That's what we did.

Diana and I went back into the bathroom, and before too long the baby was crowning.  Diana told Christine that if she wanted to move to the bed, now would be the time, but staying put would be OK too.  Chris made an attempt to get off the toilet but could barely stand, and she promptly decided that moving was out of the question.  Diana said, "No problem.  We can deliver here."  So Diana settled in cross-legged on the floor, and the nurses brought the instruments into the bathroom (which, by the way, was huge).  As Diana was prepping for the delivery, a contraction started.  I was squeezed up next to the wall still giving counterpressure, and LeeAnn and Caroline were right next to me holding Christine's hands.  Christine needed to get further forward on the seat so that Diana could have a better angle to protect the perineum and deliver the baby, so I got behind Christine and held her up by the arms.  Diana kept asking me to move her forward more and more until before I knew it I was sitting on the toilet and Christine was on the ends of my knees and I was supporting her with my forearms.  I'm honestly not sure how long we pushed that way, but my legs were numb. With one contraction Christine got very loud, and I thought "this must be it!"  Diana looked up and said "Christine, get control of yourself, you're almost there, keep breathing."  I could tell a difference in the next push--Chris was squeezing my hands and I could feel her core muscles working.  With the next push, I think we were both screaming, and then I actually felt the baby come out--I could feel all of Christine's power while she was sitting on my lap.  There was a little tug, and then Chris relaxed, and moments later Diana lifted our baby Annie onto Christine's chest, and I was sobbing as hard as the baby was crying (she had powerful lungs from the get-go).  It was just after 9:00AM.  After a few minutes LeeAnn took over my position behind Christine so I could cut the cord, and then we helped Christine walk back to the bed and lie down.

Annie was the most incredible beautiful thing I had ever seen, and I was completely overwhelmed by the delivery.  Christine had been so strong and worked so hard to grow our daughter and bring her into the world.  Experiencing her birth that way was more powerful than I could have prepared for.  It is (and will remain) the most amazing experience of my life.  Our Annie girl was finally with us after so many months, and I fell in love with her in an instant.

I have snatches of very clear memories of the delivery--of squeezing Kevin's hands harder than I had ever squeezed anything, of bellowing louder than I ever expected to, of Diana's face asking me with intensity to get control and breathe, and of this huge feeling of relief when I held the baby for the first time.  I still don't know how I walked to the bed, because an hour later I couldn't stand.  I had second degree perineal tears that Diana stitched up, and the entire time nobody even suggested moving Annie off my chest.  We just rested together.

It turned out that the reason labor had slowed so significantly during transition (and the reason I had so much back labor) was that Annie was born with a nuchal arm--she had one arm extended by her head upon delivery, so she came out Superman-style. (Interestingly, she had an arm up by her head as early as the 20-week anatomy check ultrasound, and I wonder if she didn't just keep it up there!)  She was 7lbs 5oz, born perfectly healthy after around 12 or 13 hours of labor (though all the cervical dilation happened in the last 6 hours).  There was a lactation nurse beside the bed before I even realized it, and she helped Annie and I nurse for the first time maybe a half hour after delivery.  When we were ready, Kevin went with the nurses to do the rest of the newborn exams and give Annie her first bath while I ate some breakfast and moved to our room in the Mother-Baby unit.

If you ask most women who have given birth what they remember about the experience, they'll tell you that it's hard to remember much.  While preparing for Annie's birth, I had a hard time fathoming how one forgets such an important experience.  Now, nearly 6 months after the fact, I can tell you that the forgetting is the absolute truth--it faded a little bit every time I held the baby or nursed her or napped with her.  All those fuzzy details just got fuzzier (I'm so glad Kevin wrote everything down so soon after the delivery!), and what I'm left with is an overall impression of the experience.  I am very lucky that it's such a positive and empowering impression.  When I think back on the birth, I feel proud of myself, but more than anything I feel grateful--grateful for the support I had, grateful to have medical care that truly supported normal birth, grateful for the physical and mental strength to give birth the way I wanted to.  And most of all, I'm grateful for our beautiful daughter, who made such a memorable entrance and has been making life more exciting ever since.  


Emily said...

fabulous birth story!! I love reading it from a doula's perspective :)

allie said...

How amazing! Thanks so much for sharing this. That the nurse taught Christine how to push is a fantastic reminder of how much of a team everyone can be.