Monday Feb 7th: With my due date rapidly approaching, my midwife asked if I'd like my membranes swept. I agreed -- the supervising OB for the freestanding birth center she works at requires a bunch of tests starting at 41 weeks and I wanted to avoid that, plus I was starting to become really miserable with hip pain and round ligament pain. She checked me while she was in there and I was a stretchy 3cm, 70% effaced and the baby was at -1 station. A few hours later, I began having crampy contractions every 10-15 minutes...
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The contractions continued without really changing for several days. All day, all night. But our area was under a freeze warning (it gets below freezing here once a decade or so, and the roads become very, very dangerous because no one here can drive on ice). As I live a solid 45 minutes from the birth center, I was terrified I would go into labor in the middle of the night and the roads would be icy. So I spent most of a week getting very little sleep and alternately hoping I would go into labor right away or (at night during the freeze) that I wouldn't go into labor yet.
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Feb. 12th: Saturday morning rolled around. I'd been awake for a solid 16 hours and it looked like I wasn't going to be able to sleep anytime soon, but the freeze was over. I decided today would be an excellent time to have a baby. In the hopes of getting my contractions to turn into labor, my DH, DD and I went to the store to buy some EPO and, more importantly, do some walking.
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Within 20 minutes of beginning our brisk walk around the store, my contractions changed and I began to feel them in my back. But about halfway through our store trip, while walking through the laundry aisle, I slipped on some spilled soap. Thankfully, I fell very slowly and was able to land on my knees, my giant pregnant belly unscathed. I didn't land very hard at all -- I almost fell in slow motion -- so I don't think it had anything to do with what followed.
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In any case, my contractions were becoming fairly intense and I needed to stop walking during each one, so we decided it would be best to check out and get ready to head to the birth center. I have a history of very short labors -- my first was 2 1/2 hours long -- and I really didn't want to give birth on the side of the road.
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Once I got home, I called my midwife who asked me to come to the birth center immediately because of my history of precipitous labor. I took a VERY fast shower and we headed out the door.
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As soon as I arrived, my doula ran to the car, saw I was having a contraction and asked if my back hurt. It did, so she immediately began applying very effective counterpressure. I walked into my birth cabin surrounded by my husband, six year old DD, midwife, doula, and nurse. Minutes later, my parents arrived and everyone settled in.
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For the first half hour at the birth center, my labor was intense but tolerable and I felt confident I was making plenty of progress. Based on the frequency, length and intensity of my contractions, both I and my midwife were sure I was in transition. Then I began to feel pushy, so I thought the time had arrived to have a baby. But something felt distinctly *wrong* to me, and I asked my midwife to check my progress. I was only at 6 to 7 centimeters and 90% effaced. The baby was at -1 station as he had been almost a week before.
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Not only was I discouraged, but I rapidly became certain that SOMETHING was terribly wrong. My contractions became more and more intense, far worse than either of my previous labors, both of which were unmedicated hospital births (and the second was a pitocin induction on an unfavorable cervix.. no fun at all). As the pain became more and more intense and I began vocalizing LOUDLY with every contraction, I noticed the three birth professionals in the room looking at each other with worried expressions on their faces. My doula helped me into a hands and knees position and asked me to "hula-hoop" my hips to help bring the baby down.
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At this point, my water hadn't yet broken and the baby's heart rate (checked intermittently) was fine, so everyone thought it was most likely that I was having trouble coping because of sleep deprivation. But I was overwhelmed by a sense of dread and began hyperventilating and SCREAMING with every contraction. It was nothing like my previous labors... the first, I'd been completely silent during and the second (the pit induction) I'd vocalized just a bit during transition. The pain became more and more intense, with the contractions triple peaking and only a few seconds between each. I refused to move from the side-lying position I'd settled into because the slightest movement would trigger yet another contraction. I vomited into a trash can held by my doula. I thought I was dying... I HOPED I was dying, in fact... anything to make it stop. I didn't ask to transfer, however, because that would have required me to move.
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The nurse checked my blood pressure and it was quite low, but I always have lowish blood pressure (usually around 90/55) so no one thought much of it. Meanwhile, every contraction felt as though a freight train was running over my abdomen. I was in so much pain I was barely coherent and completely unable to communicate my sense of dread. My father couldn't handle being there anymore and had to go outside for a while, and my daughter, terrified, left with him. This wasn't at all what anyone had expected.
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Finally, after what seemed like a lifetime (although it'd only been two hours since I arrived at the birth center), my body began to push involuntarily. As my son moved down the birth canal over the course of two contractions, my (still intact) bag of waters bulged from my vagina. Everyone -- except for the midwife -- thought it was the baby crowning because the bag looked dark like hair. She told me she was sorry but she needed to break my water. I agreed, and when she broke it, a thick mixture of meconium and blood poured out of me.
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Silence. And then -- "Sweetie, I know you were hoping not to tear but we need to get this baby out NOW. As soon as the urge to push comes again, I want you to give it everything you have and I'm going to help you get him out of there fast."
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As soon as the next contraction hit, I pushed as though my life depended on it. I briefly felt the midwife's hands doing something uncomfortable (I found out later he had a nuchal arm) and Liam practically shot out of me, as my previous babies had done.
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I waited those first few seconds with bated breath, fully expecting to hear that he'd been stillborn. Then a lusty cry broke the silence and my doula said "Reach down and touch your baby!" with a huge grin on her face. He was pink, perfect, angry as hell and covered from head to toe in thick meconium.
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My cord stopped pulsing fairly quickly, and when it did, I gave a sweet midwife-in-training who had helped out with my daughter the opportunity to cut it (she'd never cut one before and my husband was too squeamish... my daughter was feeling too shell-shocked to do it). Moments later, I told my midwife the placenta was coming and laughed when everyone gasped and said they'd never seen a placenta that big. I wasn't surprised because my second daughter's placenta had been over 800 grams (about double the typical weight).
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We weren't quite out of the woods yet, though. I was bleeding briskly, despite skin to skin contact, nursing, uterine massage and a shot of pitocin. Apologetically, my midwife said she needed to check to see if I'd retained any of my placenta. But the pain of the manual exploration hardly registered compared to the extreme intensity of the last hour of labor. She didn't find anything, so she administered a hefty dose of rectal Cytotec (ick) and another shot of pitocin. I kept Liam at my breast.
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It took a solid hour to get the bleeding under control, during which time I lost roughly 1500 ccs of blood. I became quite lightheaded and needed help to stand... again, not at all what I'd expected... after my previous labors, I'd been up and in the shower within 10 minutes of my babies' births. My skin was ghastly white but I begged not to be transferred, knowing that if I was, I'd be separated from my newborn for hours and from my daughter until I was home again. (The hospitals here seem to think it's still the 1960s.)
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My midwife left the room for a bit and when she returned, she looked pale and was carrying a bucket. "Do you see this?" she asked. "All of this is blood clots... your placenta was a perfectly normal size, but there was more than a pound of blood clots behind it. You had a serious placental abruption. I'd guess perhaps 80% of the placenta detached while you were in labor."
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About five hours after Liam's birth, I was allowed to go home, under strict orders not to stand without help until the lightheadedness had passed, and to take plenty of iron supplements and drink as much fluids as I could.
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Liam was fussy for the first couple of days -- perhaps the meconium had irritated his throat or eyes -- but is now a sweet, mellow newborn and nursing like a champ. He did fail two hearing screens on one side only, on his first and third day of life, so we'll be visiting an audiologist for further testing. I think, though, that there's a good chance it's a fluke because he's become much more responsive to sound over the several days. He's got a bit of diaper rash right now, maybe because we used disposables for the first several days (we're a sensitive-skinned bunch), but otherwise appears to be just fine.
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I've recovered nicely after a few days of being very lightheaded and my color is back. I'm dealing with a pretty bad postpartum headache but I don't think I'll ever look at "severe" pain in the same way again. I was also lucky enough to not experience a full-blown postpartum relapse of my MS, although my symptoms are a bit worse now than they were during pregnancy (estrogen has a suppressive effect). I did tear, but it was only a first-degree tear and easily repaired with a circle stitch. That was a great relief, given that my first birth caused a vaginal sidewall tear that extended to my cervix and my second caused a third-degree tear.
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My daughter, my husband and myself have all bonded beautifully with our adorable, gnome-faced baby boy. DD is even sweeter and gentler with Liam than I thought she would be. I wish I'd had a big sister like her!
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I will say that I'm glad I did not proceed with the unassisted birth I had originally planned. I shudder to think what could have happened. At the very least, this labor and delivery was terrifying enough in the hands of a midwife with 40 years of experience, and I fear that had I attempted this unassisted I would have wound up stuck with Liam's face-first, nuchal arm presentation... and no doubt I would have had to go to the hospital because of the hemorrhage.
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--K, mama to Celeste and baby Liam, born weighing 7 lbs 10 oz (by far my largest!) and 19 1/2 inches long.
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P.S. I feel so lucky to have a beautiful, healthy baby boy in my arms. Just a quick list of the factors working against us:
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I have MS.
I had repeated, severe UTIs during the second and third trimesters (due to the urinary retention I have from MS... I have to self-catheterize several times a day).
I had to take several medications throughout pregnancy because of my condition.
Liam presented face first with an arm bent over his head.
Severe (approx 80%) placental abruption.
Thick, particulate meconium in the water.
1500+ cc postpartum hemorrhage.
