This is ridiculously long, but a lot happened and I wanted to capture it all.
Ava Rose - born Tuesday, 10/8/13 7lb8oz, 19" long, 12.7 head circumference (length and head taken 1 week later at doctor)
On Saturday I had some brownish discharge that I figured was some of my mucous plug, but it wasn't much. We finally installed the car seat that day and I got my bag for the birth center mostly together. Nothing else happened that day, but I think that night I skipped the EPO up the hoo-ha because I wanted to be able to tell the difference between oil leaking and mucous plug, if I happened to get some more. When I got up to go to the bathroom during the night I passed a huge glob of plug that was bloody. I also had some contractions during the night that would only sort of wake me up. By Sunday morning, around 7:30 they were keeping me awake, so I started timing them, and they were coming every 2-3 minutes and lasting around 45 seconds. I felt the contractions almost entirely in my back. I kept track of the contractions for 2 hours and then called the birth center to get the midwife on call. She said it sounded like it was still early in the game, but that it was probably the real deal, and to just do normal things during the day and call back later if things picked up. I spent the day doing some cleaning and straightening up, and watching movies. The contractions kind of tapered off, with just one every now and then, so the midwife called me around 6pm and I let her know things had fizzled. I was a bit disappointed, especially because DH had taken off work that night just in case.
Over Sunday night I had some more contractions, similar to the previous night, and again started timing them in the morning when they were keeping me awake - around 6 am Monday morning. Things were much more irregular but they were longer than the previous day. I called out from work just in case. I waited a couple of hours and again things fizzled a bit, so I didn't call the midwife.
That day (Monday, the 7th) was my birthday and my parents were coming down for dinner around 6pm. I started having contractions again a little before they arrived, and I continued to have them during their visit, every 5-10 minutes I'd say. They weren't too strong and I could still be sociable. My Dad was telling my Mom she should have packed and brought a bag, since she was going to be at the birth. She planned on packing a bag when they got home that night.
After they left, DH and I hung out for a while longer, and I think we called the midwife-on-call around 10 or so. She still said it sounded early and to try and get some rest, so I went to bed, though I wasn't too hopeful about being able to sleep. The midwife-on-call said to call my preferred midwife, Kelly, if things picked up in the night, since she was going to be the one to attend me.
Just before 1 am I woke up to the most agonizing contraction. I was lying on my side and it felt like it would never end. The pain in my back just wouldn't quit. I got onto hands and knees and tried to get through it. I started losing it and was crying. I sent a gmail chat message to my husband, who was downstairs watching tv, saying "come upstairs". So he came up to find me a mess of tears from that contraction. We got into a position of him sitting at the head of the bed with me leaning back against him, and stayed that way for maybe an hour and a half while I had pretty strong contractions and tried to breathe and relax through them. It was going pretty well - nowhere near as agonizing as that one contraction that woke me up when I was laying down.
At some point we shifted position and I decided to try another contraction laying on my side, using the position Bradley method teaches for relaxation. Again, it was HIDEOUSLY painful and seemed to go on and on, even after getting onto hands and knees to try and make it stop. Cue more crying. Once I got past that we decided to go downstairs and put something on the tv.
I think I turned on some nature documentary on Netflix and continued to have contractions and breathe through them. They varied a bit, but probably averaged 2-4 minutes apart and over a minute and a half long - some longer. I just sat upright on the couch and leaned back on DH. We both drifted in and out of sleep between contractions. At one point he was pretty solidly out, so I kind of felt alone through a series of them, but it didn't bother me too much. I could just focus on them and on breathing.
I think around 5 am DH was asking me if I wanted to call the midwife. I felt really unsure, because though the contractions were pretty intense, I still wasn't 100% sure if this was it. But I started crying so I think it was clear that we needed to call. So he called the midwife, Kelly, and had her on speaker phone. He told her what the contractions were like timing-wise, and she asked me how I was feeling and I cried a little bit, so I think that told her things were for real. She said to meet at the birth center at 7 am, because it would take her an hour to get there. We live about 30 mins from it, but still needed to get some things together anyway. We also called my mom and told her to meet us there.
In the car on the way to the birth center I only had a few contractions and I was kind of worried that things were going to taper off again, and I would have gotten everyone up and moving for nothing, but I needn't have worried.
We got to the birth center at 6:50 and Kelly wasn't there yet, but another midwife had arrived before us to open the doors and prep the room for us, so we didn't have to wait. Kelly got there at 7:05, and the birth assistant Becky, arrived at 7:10. My mom got there at 7:30. (I only know these exact times because they're recorded in the labor flow sheet that they kept and uploaded to their online patient portal - all the exact timings that follow come from that log). Kelly asked if I wanted her to check me when she arrived, but I didn't feel ready. I didn't want to hear that I wasn't very far, so I declined. Just after 8 I did let her check and she said I was a "stretchy" 6 cm, 90% effaced. I was really relieved because it meant this was "for real" and I felt like I was making good progress to already be at 6/almost 7 centimeters! My water was still not broken.
The pain was still all in my lower back and Kelly wanted me to not lay back, but try to be leaning forward to encourage the baby to turn a bit more. I tried hands and knees on the bed, and leaning over the bed with various pillows and I just couldn't get comfortable. Finally I got into a "comfortable" position on a birth ball beside the bed, with DH on another ball behind me, applying counter pressure while I leaned forward and gripped the edge of the bed.
Around 9:00 I got into the big tub in the room and stayed there for the majority of the labor. I was on hands and knees for the most part and Kelly and DH applied some counter pressure to help with the back pain, which was pretty intense.
Around 11:15 according to the labor flow sheet the birth assistant notes an occasional spontaneous urge to push. I remember this feeling and it's one of the few distinct feelings that stands out now after the fact. It was awesome to have that urge just come on out of nowhere. Kelly didn't tell me to hold back, so I went ahead and pushed when I had the urge.
At 12:10 the notes say I was at 9 centimeters, 100% effaced, +1 station. Around then Kelly gave me the option of breaking my water, since it still hadn't happened and the bag was bulging. She said it could help to speed things along. I thought it over for a few contractions and then agreed, so she ruptured the membranes around 12:30. I don't recall feeling a significant change at that point, but the notes say that the baby descended when she did it. I think this point marked the beginning of the "real" pushing stage though.
I spent the next 2.5 hours pushing in various positions in the tub - including squatting, hands and knees, and leaned back with DH supporting me under the arms. I reached down several times to feel her head, which was just a little ways inside the opening. I don't know how much progress I made in the pool, but Kelly suggested getting out and maybe trying the birth stool, so I decided to give it a go. I didn't realize how long I had been pushing at this point. Someone said something when I hit 45 mins, and I was a combination of annoyed and amazed at that point. I was annoyed because I didn't want to know how long I'd been at it without getting her out, but also amazed because it did NOT feel like I had already been pushing for that long. So I don't think I had any concept of how much time had passed when I moved to the birth stool. Moving to the stool was SO hard because it was only when I stood up that I felt how low/in the way/big her head felt between my legs.
I was only on the stool for a few contractions. It didn't feel at all effective to me to push on it, and I think it was clear to Kelly that it wasn't working for me, so she suggested I get on my back in the bed. That involved another seemingly impossible movement from one location to another with the hugeness of baby in the way between my legs.
From about 3:10 - 4:28, when she was born, I pushed on the bed - flat on my back. And it was the most effective position for me! Totally contrary to what most people recommend these days, but it was only in this position that I finally felt like I was moving her down. "Slow crown" is noted at 3:40 and she continued to crown sloooowly. I was doing sets of three pushes with each contraction. I remember saying something about how I felt like she was literally IN my rectum, lol, and Kelly said that's right, she basically is! I sort of remember the stretching sensation being so intense. But it was bearable. I had DH and my mom on my right side, standing beside the bed, the birth assistant on the bed to my left, Kelly right in front of me massaging and applying compresses to my perineum, and another midwife next to Kelly on the bed, holding a mirror so I could see what was happening. DH actually watched what was happening down below the whole time, apparently because he couldn't bear to watch the pain on my face.
With each set of three pushes, I felt like my third one was always my weakest push, but I'm 90% sure that it was on a third push that she finally came out. I had already resigned myself to this contraction not being the one, and then all of a sudden, out she flew! She literally shot out of me apparently, with virtually no pause between her head and body coming out. Kelly said later that she felt me tear as she came out. I wish I could say I remember the sensation of her coming out more clearly, but I really don't. I think I just remember the warm gush of so much fluid coming out after her - there was apparently a lot, including meconium in the water. And strangely I remember the feeling of her cord trailing along my labia after she was placed on my belly. I had the urge to feel the cord, which I did - a slippery, smooth thing. I looked at her in shock and was so relieved to see she was opening her eyes and breathing right away. My biggest (irrational) fear had been her not breathing after being born, so I felt like it was all ok when I saw she was. I also immediately wanted to check that she was, indeed, a girl, because I had had this nagging worry that they'd gotten the sex wrong all along. So, we checked that, and saw the girl bits. :P DH cut the cord, though I don't remember him doing it. I did see tears in his eyes after she came out. I didn't cry at all at the time of the birth, and was kind of surprised that I didn't. I just kind of looked at her in shock and said "Oh my god, my baby!" Her Apgar scores were 9 and 10.
So, altogether, it took 4 hours of real pushing to get her out. I had no concept of it taking that long at all, and I didn't have a single worry during the pushing that it was going on too long, or anything. Kelly didn't ever give an indication that I should be worried, so I just kept on trucking, oblivious to time passing, the whole time. I did make one brief joke while she was crowning that I'd like a C-section, but I honestly felt OK pretty much the whole time. The thought of an epidural or pain relief never even crossed my mind, maybe because it wasn't an option at this birth center. But I think I had the right support and my labor was manageable the whole time. I never felt overpowered by the pain.
So, after she came out is when things started to go wrong. The usual protocol the midwives follow is to have you get into a squat and deliver the placenta within 5 minutes of the birth. So I gave the baby to DH and he held her skin-to-skin while I squatted on the bed and tried to push the placenta out under Kelly's direction (and let me say it is HARD to get into a squat on a bed after just delivering a baby that took 4 hours to push out - I felt like I barely had the strength to hold myself up). But the placenta wouldn't come. I laid back and the next hour was kind of a blur of activity. There was concern over my blood loss, and I was told to eat and drink several times, and given several homeopathic treatments. My vitals were constantly monitored. We tried putting the baby on the nurse to try and encourage the placenta to come, but I was being asked to push at the same time, and found it too overwhelming and stressful to try and latch her on at the same time I was pushing, so I gave her back to DH. The placenta still had not come at an hour after the birth. Peggy, the most experienced midwife, was in the office, and came in to assist with removing the placenta. I don't know exactly what she was doing, but she had me push while she seemed to probe and drag the placenta out with her fingers. I have to say, it was the most excruciating experience, and I'm a little traumatized over it. I would rather do the whole birth over again than go through that process of getting the placenta out. I think it took her 10 minutes to drag it out of me, but it was still not complete, so they were worried about retained pieces, as well as my blood loss.
EMS was called and the midwives continued to monitor my vitals and give me food and fluids until they came. To be honest the paramedics were not moving very fast, so it did not seem like an extreme emergency situation at the time. Once they got me on the stretcher and started to wheel me out, I did finally start to feel a little faint for the first time, but I didn't pass out. Kelly came with me in the ambulance and brought the placenta in a bag in case it was needed at the hospital. DH, my mom, and Ava came by car separately and met us in the emergency room. It took them quite a bit longer to get there because it was the middle of rush hour traffic. I was given IV fluids and pitocin in the emergency room from what I can recall. An OB came in and discussed what we'd need to do, which was a D&C for the retained placenta, and also to repair my tearing, which the midwives had not even been able to properly assess due to dealing with the placenta. I was taken up to the OR and we discussed what kind of anesthetic I'd get - we went with general for…I dunno all the reasons. Kelly later said that she requested I be put under light sedation rather than full general so that I could come out of it faster and bond with the baby sooner. I remember waking up and being totally disoriented and resisting the staff when they tried to put an oxygen mask on me and do various other things. I was really upset because I felt like they were talking to me but I wasn't awake enough to comprehend them, and they didn't take that into consideration. Later I was told that my vitals were pretty bad during the procedure, and it was actually touch and go for a while. I received three bags of blood in the end. I was finally taken up to a room in pediatrics, which had been somewhat specially arranged for us so that DH, my mom, and Ava could all be with me. It was an out-of-the-ordinary situation for them since Ava was not born there and was technically not a patient. It was a double room, but we ended up having it all to ourselves. I had antibiotics and fluids, and was a bloated swollen mess when I came out of the OR apparently. When people saw me the next morning they said I looked like a completely different person. I stayed for two nights because I had a catheter and we didn't take it out until the second evening, and it took a while for me to be steady enough on my feet. Regarding the tearing - I had second degree tears into the vagina on both sides. The OB said that the majority of my bleeding was actually coming from the tears, not the uterus.
I've been pretty emotional when reflecting on my birth experience. As I was pushing near the end, and knew that I was near to getting her out, I already felt triumphant, and was looking forward to saying that I had the birth I wanted and did things my way. And it's true that I did. But everything that happened after she came out has really put a damper on the experience and my perception of it. When it became evident that I was going to have to transfer my first thoughts were to feel guilty and worry that my husband would blame me if something really bad happened for insisting on an out-of-hospital birth. As I was being wheeled out on the stretcher I said "I love you" to him and then I was starting to feel faint. I thought to myself "Ok, the midwives said to tell them if things started to go dark or if they started to seem far away, so maybe I should say something to the paramedics here." So I said "It's starting to go dark." No one really seemed to be concerned or pay much attention, so it seemed pointless that I said it, and I didn't pass out after all. But my DH heard my say that and he told me later that he thought I was going to be dead when he got to the emergency room. The thought of him being scared like that really affects me. And then I didn't get any good bonding time with Ava until the next day really, and even then it was tough because I was so immobile in the bed, and trying to pump colostrum because she wouldn't latch, etc. Instead of spending a few hours at the birth center and then going home to enjoy our little family, I had a scary hospital stay where I could have died. I don't know how my care would have differed if I had delivered in a hospital, and that's part of what nags at me. Being in a hospital wouldn't have magically made my placenta detach properly, but I don't know if my blood loss and vitals would have remained more stable there. I probably wouldn't have been allowed to push for four hours in the hospital, so I wouldn't have had that experience, at least. I guess it wouldn't be comparing apples to apples to try and imagine how it would have gone in a hospital. It just would have been completely different in general. But now I have a lot more to think about regarding my next birth, and where I'll feel most comfortable birthing then. I feel like I received excellent care from the midwives, but they were working within the limitations of their credentials (CPM) in my state and could not do certain things for me that CNMs or a hospital setting would have offered. And the fact that I pushed for four hours… I dunno if I should feel accomplished or disappointed that it took so long. Before I knew how long it took I felt fine about the pushing, but knowing how long it took, and hearing about people who push for 10 minutes…it kind of bothers me.
Of course I'm so happy that Ava is here and is beautiful and perfectly healthy. But I'm sure I'll dwell on the birth for a long time and re-evaluate how I feel about what happened many times.