The birth of Josias Alasdair Emmanuel M.
Here is the short but beautiful version of the labor and birth of our son--a video montage compiled by our doula (the opening music was actually my labor music--the hauntingly beautiful O Magnum Mysterium by Morten Lauridsen): http://www.youtube.com/watch?v=ZBFU1GBs5Bs .
And here is the (much) longer story which, though less poetic, is the realistic version of natural induction and birth--an amazing and excruciating experience:
The Natural Birth of Josias Alasdair Emmanuel M.
Born in the Forest Room of the Midwife Center
July 20, 2012
On July 17th, I called the Midwife Center to schedule an appointment for the afternoon of Thursday, July 19th—exactly one week past my due date. On my actual due date of July 12th, my husband, Timothy, and I had gone to the Midwife Center for a breast-pumping/walking session which we hoped would naturally induce labor. Though I did have contractions while there, they were not able to remain consistent and strong. We returned home and began the process of waiting and hoping that labor would start on its own, and a few days later on Saturday, July 14th, it seemed to do just that. We dressed our daughter in her “big sister” shirt, telephoned Kathy, the midwife-on-call, to give her a heads up, and did lots of walking in the hopes of strengthening my contractions which, though regular, were not terribly strong. Unfortunately, despite all our efforts and enthusiasm, after 12 hours my contractions stopped altogether. So, when I called the Midwife Center on July 17th, I told them that I wanted to have a Foley catheter inserted to help my cervix to dilate. At this point I was getting very discouraged that I had not gone into labor on my own--something that I had no issue with for our elder daughter’s birth (she actually arrived punctually on her due date!).
We held the vision of another non-medicated birth, but were internally worried because an ultrasound at the beginning of July indicated the small possibility of shoulder dystocia, a condition in which the baby’s abdomen is larger than the head, causing the shoulders of the baby to become stuck at delivery—quite a concern! The ultrasound also predicted our baby’s current weight to be 9.8 lbs the week prior to his due date. After talking with several midwives and being examined, they agreed that the baby felt no larger than upper 8 lbs, which coincided with my internal feelings, having carried a nearly-eight-pound baby previously. Having consulted the overseeing OB at the Center, the midwives told me that they were agreed that as long as the baby was less than 9 lbs I would be able to deliver in one of the birthing rooms at the Midwife Center, as my condition was still “low risk” enough to avoid a hospital birth, something I was keen to do if possible. Obviously, though, time was an issue and we needed our baby to be born sooner rather than later to prevent a mandated hospital birth, and to lessen the risk of an emergency during delivery. With this in mind, we had gone in to hopefully start labor on my due date, but when that did not work, Kathy, the midwife who had overseen the process, suggested we wait it out until the middle of the following week to see if labor would start naturally. Though I felt mild contractions increasing each day, there were no signs that serious labor was imminent, and I was quickly approaching the 41-week mark. I knew the clock was ticking.
Thankfully I was able to schedule a 2 p.m. appointment on Thursday, July 19th, again with Kathy, who, incidentally, happened to be the first midwife I had ever seen at the Midwife Center. I called Becca, our doula, and we decided to meet up for lunch that same day at a nearby deli, which was right behind the Midwife Center, and agreed that she would then come with us to my appointment. She was excited to assist at a birth there and was looking forward to the experience. At about 1:45 p.m., Becca looked at her watch and said we should probably head on to the Midwife Center. Tim told Becca where to park and he and I walked briskly—by now there were large raindrops beginning to fall—and made it to the Midwife Center just in the nick of time to avoid a downpour. Heading up to the waiting area, I did my standard routine of bathroom break and weight check, and then Tim and I sat down on the comfy sofa to wait, perusing the chalkboard listing of all the new babies who had been born in the last month, one of our favorite “waiting room” activities over the last nine months.
Becca arrived a few minutes later followed by Kathy. I introduced Becca and explained why she was there—talking about our fear of a possible hospital transfer—and Kathy seemed happy with her presence. She took us back to the farthest examination room—actually the same room where we had met Kathy at my first appointment--and I changed into a gown so that I could get checked. It’s rather interesting that this room is where our journey began at the Midwife Center and then where it ended, though only in retrospect did we realize it.
Our original plan had been for Kathy to insert the Foley catheter, but after checking my vitals and hearing the baby’s heartbeat she examined my cervix and said that I was already 3-ish cm. dilated and very stretchy and effaced so at this point the catheter would be useless because the entire point of it was to get a cervix to where mine was already. This was both encouraging and discouraging news at the same time. Knowing that we really needed to birth soon because of the shoulder dystocia risk and already being one week past my due date, I asked her what our options were and she recommended we try breast-pumping and walking again. In my heart I was afraid that we would simply have a repeat of our July 12th scenario—initial contractions that never develop. However, that seemed the best natural option at the moment, and it was encouraging that my body had progressed a lot further in a week. I mentioned that I had been having more and more Braxton-Hicks contractions, and after 12 hours of steady contractions on the previous Saturday it seemed as if my body was trying to labor but maybe it just needed a little nudging to do so.
So instead of having the catheter inserted and then going back home, which was our original plan, we agreed to go ahead with pumping and walking, with the idea in mind that if it did not work this time we would come back the following morning for another session. I redressed and then Tim, Becca, Kathy, and I all went downstairs to the Forest birthing room where we were met by the smiling face of our nurse, Diana, who had also assisted at our July 12th pumping/walking session. It seemed almost like an exact repeat of the week before! As we entered I saw that the small embroidered pillow hanging on the door had been turned again to "Birth in Progress" and secretly I was beaming and even giddy, though at the time I was afraid of getting my hopes up. The bed had been prepared with waterproof mats, the lighting set low. I gazed up at the two large ceiling fans and chatted with Diana. Yes, this was MY room, the place where I instinctively felt that I wanted to birth, if our little guy would ever be willing to come out.
In the meantime, Kathy had sent a cell phone text to Emily, the midwife-on-call for that day, to let her know what we were doing so she could come in to check on my progress. Once we got settled in the Forest room, I encouraged Becca to go home and enjoy some family time and said that we would call her if it looked like labor might be underway. After she left, I got hooked up to the breast pump and began having contractions almost immediately, which felt stronger than they had the previous week. After my first round of pumping it was still raining outside, so Tim and I were encouraged to walk inside the Midwife Center. This was harder done than said, since it is a narrow space and, being mid-day, there were lots of other people coming and going for appointments. We found a back staircase at the end of the second floor hallway, past the examination room I had been in with Kathy the hour before, and Tim kept me company as I trudged up and down the stairs, over and over, checking the raindrops at the window each time we did yet another round.
After our 25 minutes of walking was over, we went back to the Forest room, and there we were met by Emily. She asked if a non-stress test had been done, since this was standard practice for being one week past one’s due date, and we said no, so she had Diana hook me up to an electronic fetal monitor to do a non-stress test before resuming the pumping and walking. The non-stress test simply monitored my contractions and the baby’s heartbeat to check for accelerations and decelerations. I was really excited that my contractions were continuing, and the EFM confirmed this. Tim and I greatly enjoyed watching the needle peak at each one, which was something in the range of 6 in a 20-minute time span—very encouraging! The baby seemed to respond very well to each contraction, and Diana’s enthusiasm at this news was contagious. Things were looking good!
After being examined by Emily, who felt that I was 4 cm. dilated by that point, we went back to pumping. Thankfully, the rain outside had abated and Tim and I decided to walk out in the fresh air, realizing as we did so that Tim had not packed a change of clothes and so he was in his khaki work pants, dress shirt, and thick socks and shoes, all of which were less than ideal for a summer walk and possible all-night labor, but neither of us had really believed that today was going to be THE day (after all, we were supposed to be going back home!) and, though things were getting more promising by the minute, it was too late to do anything about it. Thankfully, being late in the day (it was around 5 p.m. by this point), the temperature was milder and the sun low enough in the sky that the sidewalks were all shaded, though after the rain the air felt somewhat humid and tepid--a true July summer evening.
We decided to walk in a different direction than we had on July 12th so that we could explore the famous Pittsburgh “Strip District,” and take a look at the specialty shops as we meandered. Tim made several phone calls to family while we walked hand in hand, and I’d squeeze whenever I felt a contraction so that he could time them while chatting on the phone. The contractions seemed to come every few minutes and were moderate in strength. I was still able to talk and laugh, and Tim and I were both enjoying each other’s company and conversation. It seemed to be our last “date” before becoming a new family of four! We were both internally brimming with anticipation.
When we returned to the Midwife Center we reported our excitement that the contractions seemed to be getting stronger and closer together. We did another pumping session and went out walking again. By this point in walking, I was feeling tired and the contractions were definitely longer and stronger, lasting between 45 and 60 seconds. Becca, our doula, called us to check in and we told her that we were actually just about to call her to tell her to get ready to come meet us. Everything was pointing to a birth that night—a fact I had not even dared to believe that morning—though in my head I knew that our baby had to come out … eventually.
When we arrived back, I sat on the birthing ball and Tim and I each ate a quick, microwaveable pasta dish and a side of cheddar cheese and crackers, following Emily’s advice of “you may want to eat now because you may not be able to later.” Afterward Tim and I went out for one last hour-long walk, walking quite a long way to explore the façade of a huge brick and gold church in the Strip District. Upon coming back, Emily thought I was then dilated to 5 cm. and we discussed options since it seemed like things were progressing but doing so slowly. Her recommendation was to break my bag of waters to intensify the contractions and commit to birthing within the next 24 hours. Thinking through the possibilities—I really wanted to be back home with our daughter, Cecily, as quickly as possible, so the idea of a long and drawn-out labor did not seem welcome, plus we knew we needed to birth this baby soon to keep alive the hope of delivering at the Midwife Center, not to mention we really wanted to meet our little guy—we agreed to go through with that procedure.
At 6:35 p.m., I laid on the bed of the Forest room while Emily broke my water and amniotic fluid came gushing out. The water was stained with light meconium, which Emily said was expected for a baby who was postdates (meaning, after his due date). At this point they gave me some Depends-style undergarments to wear and I continued to labor on the birthing ball by the bed. Soon after, I had three contractions in a row and each time I felt a strong gush of fluid come out. I went to the restroom and to my surprise amniotic fluid gushed all over the floor. Emily said that my body had not gone into labor on its own probably from the sheer volume of amniotic fluid, which stretched my uterus to prevent it from contracting effectively and it cushioned the baby’s head too well, preventing the head from pushing on the cervix to dilate it. Knowing this abated the internal anger I had felt toward my body’s inability to go into effective labor. It was so nice knowing why things hadn’t progressed and we felt like agreeing to an “artificial rupture of membranes” had definitely been the right decision to make. We greatly appreciated having the expertise of our midwife but in a way that still let us be in charge of our labor experience, where we were empowered to make decisions surrounding our birth process.
I knew that once my bag of waters ruptured that the going would get tough, as now the baby’s head would be pushing directly on my cervix without any sort of cushion. At this point it seemed like every time I moved I would be overwhelmed by a painful contraction. Several times I hung on to the tall wooden bed post nearest to me to ease me through contractions. Emily felt that under the circumstances I could still expect a natural birth in the Forest room, as the baby felt to her to be still in the 8 lbs range and the meconium was light--though she did say she was slightly worried that with my amount of amniotic fluid, which was about double what she expected, that it could have diluted a thicker amount of meconium, thus indicating a sign of possible fetal distress. All-in-all, though, everything still seemed like a green light. I was very excited and relieved to hear this news, as I had pretty much resigned myself to expecting to be sent directly to the hospital being a week past my due date. I greatly appreciated that Emily asked me what size I felt the baby to be, saying that maternal intuition was often right, and that my saying that he felt in the 8 lb range influenced her decision to agree to trying to birth at the Center even with the ultrasound’s label of “possible shoulder dystocia” hanging over our heads. It was a pleasant relief to have her put so much faith in me.
The nurse, Diana, monitored the baby’s heart rate through contractions, and that seemed well, so we continued to labor as we had been on the birthing ball. At 7 p.m. the nurses changed shifts, so I hugged Diana and thanked her for her help and met the new night nurse, Shannon. By this time I was in pain and getting fatigued, so I asked if I could get in the tub. At this point I was totally naked, and really didn’t care one iota, despite having packed the top to my swimsuit for laboring somewhat modestly. The contractions hurt and I was exhausted from having walked so much, not the easiest thing when one is massively pregnant! I tried several different positions, and I liked a sit-squatting position best with a water jet aimed at my lower back. I kept my eyes closed the entire time I was in the tub. I was trying to relax and muster some much needed energy for the task ahead. At some point, I know Tim started singing the Taize chant “When the night becomes dark, your love, o Lord, is a fire.” At the time, it sounded to me far off in the distance but it was most welcome and calming. I was going inward, which I knew was a good sign that labor was moving forward.
At some point while Tim was singing, Becca, our doula, arrived. I know that Tim and Becca chatted a bit, and I was glad that he had someone to distract him a little from the mental and physical rollercoaster that we were on. I remember Becca getting out some faux votive candles and putting them beside the tub for a more relaxed atmosphere. I have no recollection as to how long I was in the tub—probably an hour—but after Shannon had checked the baby’s heart rate, Emily asked me to get out of the tub because it seemed like he might be getting overheated. I knew in my heart that getting in the tub would also slow down my labor progress, which is the double-edged sword of laboring in water: the water helps you to get rest and manage the contractions, but it also slows down the labor process.
Apparently while I had labored in the tub, Emily had asked Kathy to come back in to assist with delivery knowing that shoulder dystocia was on the radar. When I got out of the water Tim fetched me my soft navy shirt and, after wrapping a towel around my waist, I sat again on the birthing ball and did another round of pumping since, after being checked, I was still only at 5 cm. dilation. It was so difficult holding the breast pump steady during contractions! I noticed then that my feet were cold, and realized that I had failed to pack any socks—neither Tim nor I were as prepared as we should have been--so Tim took off his and gave them to me. Someone, I’m not sure who, maybe Tim, encouraged me to get into an all-fours position on the bed while leaning onto a birthing ball, hoping that would help the pain, so I tried that for a while. I also asked Tim to put on the music we had brought—the ethereal “O Magnum Mysterium” by Morten Lauridsen—which speaks of the great mystery that God chose lowly animals to be the first to see the newborn Lord lying in a manger—a song I had fallen in love with and thought would be the perfect background for birthing.
After pumping, we again walked the halls of the Midwife Center. At this time I would breathe through my contractions while standing upright and, considering I was wearing only a shirt and a bath towel, I was very grateful that it was nighttime and there were no other families coming and going. At this time Becca went off to the kitchen to grab a sandwich, and Tim and I walked and labored alone, still wondering if all of this would end in a hospital transfer or not, and in my head I was still worried that by choosing to stay at the Center rather than agreeing in advance to birth at the hospital that we were putting our unborn child and myself at greater risk of possible life-threatening complications. However, we felt confident in our midwives’ abilities and intuitively we felt that a natural birth would be an easier and more pleasant experience at the Center where, being in the calm of nighttime, we did not have to worry about bright lights and paperwork and shifts of medical staff. We could simply labor in peace and listen to the distant laughter and chatter of Kathy and Emily in the kitchen as we walked the staircases once again. We knew that if either I or our baby were in imminent danger, we would be in good hands and could fully trust the advice and care of those looking after us. The Midwife Center in many ways that late July night felt like a womb for me—a sacred space—with each contraction birthing me as a mother.
After half an hour or so of walking, Emily examined me again. It seemed like my cervix had not continue to dilate, as I was still at 5 cm. My heart sank. Emily sat on the bed and had a heart-to-heart chat with us. At this point, she said, she recommended a transfer to Mercy Hospital where I could be given Pitocin to speed things up and continue to progress. Emily voiced her concerns: 1) The meconium-stained amniotic fluid, of which she still was uncertain as to whether it was thicker meconium diluted by my vast amount of amniotic fluid or actually just "light meconium,” 2) The possibility of shoulder dystocia, and 3) My failure to further dilate while I was in the tub and afterward. She said it was just several little things that were adding up that made it seem like I needed some Pitocin to push things along. I asked a few questions about logistics (food, where to go when we got there, the nursing staff—knowing that only Emily would be going with us--and if she thought I would still be able to have a non-medicated delivery hooked up to a Pitocin drip). The idea of Pitocin-induced contractions terrified me, quite honestly. I already felt that I could barely keep on top of the natural contractions I was having, and that by introducing Pitocin my body would not be able to increase my endorphin levels enough to handle them (I had read in Dr. Sears’ The Birth Book, which I had borrowed the month before from the Midwife Center’s lending library, that this is an issue in any induction situation—the body does not have time to gradually rev up endorphin levels to meet the pain needs caused by artificially-induced contractions). However, Emily said that a natural birth was still doable under those circumstances, and Becca agreed that it was very possible and assured me that I could do it. I asked Tim his thoughts on whether we should transfer, and he said the decision was up to me. In my head, I was thinking that if we did go to the hospital I was going to get an epidural. I didn’t think I could take stronger contractions and I was already feeling physically and mentally exhausted (it was approaching 11 p.m.) not to mention discouraged. I was also afraid of riding in the car—I remembered only too well going through Transition in the car for the birth of our daughter and how painful that was—and I was afraid of all the paperwork and bustle that nurses must do to admit you to Labor and Delivery, and how that had temporarily stalled my first labor. It felt like anything that was going to slow my labor down significantly needed to be avoided if I wanted to avoid the slippery slope of medical interventions ending in c-section. Emily said the decision was up to me but she did recommend a transfer at this point. She looked at me, thoughtfully, waiting for a response.
Thinking it through, I felt that I didn’t need much more to be able deliver at the Midwife Center. Even though I was not dilating as we had expected, I felt that labor was actually progressing by examining my internal feelings, having gone through the stages of labor successfully before. I also knew that I could dilate the remainder in half an hour quite possibly, as I had read many, many birth stories in preparation for this birth. The baby’s heartbeat had remained strong through all my contractions, and so I felt that I just needed a little more time and that things would progress if we waited it out. I asked if I could try walking again and then get re-checked; if I had progressed then maybe we could stay, and otherwise, I’d agree to a transfer. Emily seemed hesitant but agreed to let me walk again for an hour. Again, I was very appreciative of having a voice in my labor process.
This time Tim, having read in Dr. Sears’ book about different laboring positions to speed up labor progress, suggested that while we were walking I try squatting during contractions rather than standing as I had done previously. I remember feeling like that was going to be impossible, but he suggested I hold his hands and squat while pushing my head into his mid-section at each contraction. I knew that this would speed up dilation but that it would be difficult and painful. However, since time was of the essence, I felt I had very little choice but to try it as our last resort. And so we entered the halls again—me walking first, followed by Tim and then Becca. I realized quickly that the only way I could squat was to do so at the first inkling of a contraction. Once the contraction was in full swing, squatting was impossible. As soon as I felt the slight twinge of tightening, I’d hold Tim’s hands and squat and breathe out through my mouth. In both the books Birthing from Within and Hypnobirthing, the authors suggested mental imagery to help one not focus on the contractions, but I didn’t find that advice helpful in the moment during this labor, though I had used imagery successfully with my first. There was no way I could think or process this time, only feel. With each strong contraction I would breathe in and out as deeply as I could. This labor was getting more intense, and I knew it was getting closer to the end. I prayed that this time there would be progress.
Walking the halls and stairways of the Midwife Center, I felt a great surge of gratitude for the darkness of the night. I was so glad for quiet, for peace, for the velvety night. I was so glad that I was the only laboring woman at that time. I remember walking by the picture tucked in the corner of the stairway leading up to the third floor of the Midwife Center and which was of the first birth at the Center’s current location, and I remember taking heart each time, thinking, “I can do this, too!” I also remember looking at the angel figurine placed in a nook in the brick work of the main stairway and reminding myself to center and find peace through the storm. I wanted to sear these images into my mind to recall later when I looked back at our birth experience. I wanted to remember the feelings, the surroundings, the spiritual essence surrounding us—the things that were more than just “facts” about our birth—the things that made the Midwife Center a haven for our birth. I thought of all the women who had tread those stairs before I had, each one aching through every contraction, wishing it would all be over soon, but welcoming each one as a step closer to being able to gaze into their new baby’s deep blue eyes. I would take strength from those mothers whose presence I could almost feel, and strength from within myself, believing with the verse in Philippians that “I can do all things through Christ who strengthens me.” I hoped that long after I had delivered our child maybe some other mother would feel my presence in those hallways and draw her own strength from that as I had done. I was leaving the memory of my footsteps, of my hopes, of my fears, of my dreams.
By now, I was getting really tired after so many rounds of walking up and down three flights of steps. At some point someone, either Becca or Emily I think, suggested we go back to our room, and I agreed, as I was so fatigued by my contractions, not to mention that I was in the part of labor where one cannot think but only follow. As soon as I got back, I had Tim come with me to the restroom (since I always seemed to have multiple contractions while there, and I felt that I needed the comfort of his presence through them by this point), and it was then that I felt my body starting to push. I remembered this sensation from our first birth, and welcomed it, knowing that this meant that all had not been for nought. Tim told Emily, who then wanted to check my dilation. At this point she said I was at 6 cm., and I felt incredibly discouraged after all that I had been through. I was thinking, “Only six?” I wanted to cry but I had no energy left to do so. However, since I was having the urge to push and I was about to have a contraction, Emily checked me through that and found that during a contraction I was dilating to 8 cm. This was a turning point. I think we all knew now I was entering the Transition phase of labor, so someone—probably Emily—suggested I get back in the tub, and all thoughts of transfer disappeared. It was like the sun breaking out from behind the clouds. Emily seemed enthusiastic and encouraged, which really helped me because I was so mentally vulnerable at this time (another sign I was entering Transition). I remember her words which really carried me through this part of labor: “Allison, just follow your instincts and you do whatever your body tells you to do.” That meant so much to me: It meant that I was again in charge of my labor and that my body was doing exactly as it needed to do. It was also such a change from Cecily’s birth, where my body was pushing for an hour (I was at 9 cm. dilation at that time) and I was told by my physician not to push because I wasn’t fully dilated, and I kept thinking, “How can I NOT push? I’m not consciously doing it!” It meant that unlike my previous birth experience, Emily trusted me and she trusted my body, and that I could trust myself.
It was now half after midnight, and I remained in the tub for about 45 minutes. I honestly don’t remember this time—it was as if I were in a trance. I remember a few times having to fight down nausea (which is apparently common during Transition) and somehow managed to stay on top of it. All in all, I just remember constantly contracting and contracting and at some point (I now know it was around 1:15 a.m., but at the time it seemed as if the world was standing still) Emily said I needed to get out of the tub so I could push (Emily had told me in advance that with our fear of shoulder dystocia that an accidental birth in the tub was very important to avoid.) I got out in between contractions though I was so nervous I’d have another contraction before I could even make it out since it seemed that any movement caused me to contract again. As if my body heard my thoughts, I was able to make it out of the tub and hold on to Tim before contracting again.
Emily asked how I wanted to push, and I realized that I really wasn’t capable of figuring this out right then. My thoughts were muddled, and I couldn’t think an entire thought before contracting again and needing to go inward and focus on that. I think I said I wanted to try standing up, but after assessing the situation after one contraction, Emily suggested I get on all fours on the bed. Someone got me a birthing ball to lean on, and I held Tim and Becca’s hands. I don’t remember pushing being so painful with Cecily, but it was excruciating this time. Each time I had a contraction, everyone shouted “push push push” and I did my best to push along with the contraction. In the beginning of pushing, I know I was yelling. It actually shocked me because I was so quiet at Cecily’s birth. As I said, pushing this time was excruciatingly painful and I was so very tired at this point. After several contractions with me bellowing some really primal, guttural sounds (have I mentioned enough that I was really grateful that it was nighttime and we were all alone in the Midwife Center?), Emily asked if I could use that energy to push harder instead of shouting out (I can’t remember how she worded it, but it amounted to that).
It honestly seemed as if I was pushing for hours, but it was actually only a little over 30 minutes—from 1:15 a.m. to 1:52 a.m. I would contract and push and push and push and then I’d run out steam, as would the contraction, and it seemed to me like the baby would never come out. I would collapse onto the birthing ball, and then I’d feel the rise of a contraction and we’d start over. Between pushes I felt Emily apply a warm compress to my perineum (she had a slow-cooker with water set up for that very purpose, and early on in labor we had asked what it was for , and she had joked that the midwives were planning on cooking a batch of meatballs!). The warmth of the compresses was my one comforting sensation at this point. Finally, I had a long contraction, and I pushed about 7 or 8 times in that one contraction. I felt the “ring of fire” during one of these pushes but, honestly, everything hurt so much that it really did not faze me other than make me feel encouraged that labor would end soon. And then, as I continued pushing in that one contraction, I felt a wet, jiggly mass come gushing out—the most amazing sensation I have ever felt in my life. It was 1:52 a.m., though I didn’t know that until Emily called it out for it to be noted down in the record. I knew it was our baby and I think I just draped myself onto the birthing ball, absolutely exhausted. Neither Tim nor Becca knew I had delivered, and so they were both still telling me to “push” until Emily said that our baby had been born. Tim and Becca both laughed realizing that they had not even noticed. Emily had to cut his umbilical cord right away because it was wrapped tightly around his neck, which she said was why I was having difficulty pushing him out, as his cord kept tugging him back in.
I think it was a blessing that I was facing the other direction (being on all fours) when our son was born because, with his cord wrapped around his neck, our baby had actually turned gray and seemed wilted and lifeless, according to Tim. I knew something must be wrong because I had not heard him cry, but I was so tired and so relieved to be done with the worst part of labor that I didn’t have any energy left in me to worry. Kathy (the other midwife present) and Shannon (the nurse) were working to suction the baby’s lungs and give him the extra TLC he needed. I knew our baby was in excellent hands. I trusted them. I saw their quiet demeanor and deliberate movements, none of which indicated an immediate emergency, so I had full trust that in a matter of minutes I would be gazing at my child’s sweet face. After a few minutes, when he did start to cry, they held him up for me to see, and tears just welled in my eyes. Here was my child. Here was the person I had waited so many long months to meet.
While I waited to hold our baby, it was time to deliver his placenta. I turned over onto my back and Emily confirmed that we had agreed to an active delivery of the placenta, which meant not waiting for the placenta to come out on its own but having the midwife work to gently tug it out followed by a shot of Pitocin. We had agreed to this procedure because of its track record at reducing maternal hemorrhaging, which we had been told at a previous appointment was a greater risk when one delivers a larger baby. I contracted again and Emily pulled as I pushed the placenta out. She then gave me my shot of Pitocin in my thigh, followed by some shots of local anesthetic in my perineum so she could stitch me up. Apparently, I tore along the scar from the episiotomy I had with Cecily. Emily said she could see that it was wanting to tear during my final pushing and she tried to hold it together but it tore anyway. Tim asked me later if I felt it tearing, and I said no, that I had no idea. His reply was that it was very telling how painful labor must be if one can rip a piece of flesh the length of one’s lip to one’s chin and not even notice it. I replied that one of the reasons I chose natural labor is that by doing this I know that I can physically and mentally survive anything. By doing so, I can realize my own strength as a woman. Birth is paradoxically one of the most excruciating and amazing experiences a woman can ever undergo.
As quickly as it was safe to do so, Shannon brought our baby over to me and he snuggled on my right side while Emily finished stitching me up. (At some point while lying there, I had to blurt out to her, “How on earth does anyone do this in the Bush? I absolutely cannot fathom women who go off by themselves to the jungle and birth all alone!” My one consolation during my labor was being surrounded by lots of loving hands and kind words!) After we snuggled for a bit, Emily took the baby over to weigh and measure him. She asked us each how much we thought he weighed, and then she checked the scale: He came in at 8 lbs, 4 ½ oz, and 20.5 in. in length, so not the whopping 10+ pounder predicted by the last ultrasound at the beginning of July. His abdominal measurement was also not larger than his head, so the ultrasound had been incorrect on all counts. Emily’s opinion was that because I had an insane amount of amniotic fluid the last ultrasound was distorted. Thankfully this meant no shoulder dystocia issues!
Becca asked what we were going to name him, and I told her Josias (pronounced jo-SY-as) was his first name, a Greek variant of the Hebrew name Josiah, meaning “God heals,” and that Tim and I had agreed upon Alasdair as one of his middle names to honor my Scottish heritage, but that the second middle name was up to Cecily. We had agreed as a family to either Josias Alasdair Crispin or Josias Alasdair Emmanuel, but we were going to wait until the morning for Cecily to make the final decision. She had been to nearly every midwife appointment, during which she helped check my blood pressure and find our baby’s heartbeat, not to mention that she had agonized with me over name books for months, so this baby was as much hers as he was ours. We had a new son, she a new brother, and we were all going to give him the blessing of a name from each of us.
After Emily was done measuring and weighing Josias, she brought him back to me and gave me a hug, telling me how great I did. (Midwives of all people know both the miraculous and physically exhausting nature of birth—an experience that creates a special bond between all of those who share in it.) She was very kind-hearted and said that she was so proud of me and how by following my instincts I knew just what to do. Those are fantastic words to hear after you’ve delivered! I’ll never forget her smile—it was beaming like sunshine. Shannon then went to make me an egg and cheese omelet with a buttered English muffin, and both Emily and Becca packed up for the night. Tim called my parents to tell them the news, and they spent the rest of the night calling everyone else so that we could have some bonding time together.
Over the next few hours Tim and I chatted all about our labor and birth experience and admired our beautiful little guy. Finally, around 5 a.m. we all fell asleep together, with me holding Josias cradled in my arms. At 8 a.m. a new nurse, Priscilla, came in to check our vitals, and Tim called his parents to tell them the news, and then called my parents to check in. At 9:30 a.m., my parents arrived with Cecily and breakfast. Later that morning, Josias Alasdair Emmanuel Marsh was finally named. (Cecily said he just looked like an Emmanuel to her.) At lunchtime, we packed up and headed for home to start our new journey as a family of four. As we were leaving we passed a family headed up the stairs to a prenatal appointment and then as we approached the front entrance we saw Kara, another midwife, as she was quietly closing the door to the Ocean room: another mother was in labor that day. It was truly a circle of life.
At our two-week postpartum check-up, we saw the name of our son listed on the waiting room chalkboard of the Midwife Center—an event which we had long anticipated with excitement, and one that seemed at times as if it would never come. After so much waiting, our son was finally here. It was an 11-hour labor of deep love, but one in which the memories will endure a lifetime.
Looking back on our experience, I am so grateful for the hand of God, who graced us with our precious little boy and who wonderfully knit him together in my womb. I am so grateful for the caring hands of all the midwives, who monitored his growth as we waited for the time of his birth. I am so grateful for the gentle hands of our delivery nurses, who cared for me during my labor and listened to the thumping heartbeat of our child to ensure that we were both healthy as we went through this experience together. I am so grateful for the encouraging hands of our doula, who believed in us and helped me to trust myself. I am so grateful for Kathy and Shannon, who helped take care of our son after his birth when he needed their help, and who literally gave him the breath of life. I am so grateful for the skillful hands of Emily, who with kindness and expertise helped welcome our little one into the world and helped me to become a mother again. And lastly, I am so grateful for the strong hands of my husband, who held me through one of the most difficult and incredible experiences of my life. Thank you from the depths of this mother’s heart.
Here is a link to our Birthing Center, The Midwife Center of Pittsburgh, which we highly recommend: http://www.midwifecenter.org/default.asp?iId=GFEEFG .