During our pregnancy I asked my mom friends about their birth stories. I was surprised how many progressive women delivered in hospitals, opted for epidurals or who embraced cesarean sections as a normal birth option rather than as a last resort after natural birth options had failed. Intuitively it seemed that a natural vaginal birth would be the most ideal for a mother’s health and for the alertness of a baby. I knew my goal was to have a birth experience that would give Evhe Simone a great start into the world as well as give me a chance to experience this uniquely female experience. I didn’t want medication or interventions to reduce pain, speed along labor or to impede my body’s ability to do what it was designed to do—to give birth naturally.
I had never experienced extreme pain in my life and had no idea what my tolerance might be but as a yoga practitioner interested in health and wellness, I trusted my body. Mark and I searched for a birthing situation that would match this natural philosophy. Hospitals seemed like a challenging choice because of their terrible rate of interventions such as epidurals, episiotomy, use of forceps, vacuum extraction and cesarean section. C-sections in Maryland hospitals occur in 34% of births. Alternatively, we looked at a Maryland birth center where a midwife is present but where there is some hospital affiliation. They have a 7% C-section rate while MD home births have a 3.5% rate of births that end up in cesareans.
Though admittedly I have a general mistrust of western medicine, objectively the odds were in favor of the alternative settings. After much consideration, we decided to do a home birth and to also get care with a shadow midwife practice that worked out of a hospital in case we needed to go that route.
On Wednesday December 11, 2013 at 5 a.m. I went into early labor. When I called our midwife she said it was false labor. I was not sure what this meant. I knew about Braxton Hicks where your belly hardens in a contraction and then softens. I’d had these throughout pregnancy and they were not associated with pain. For me this false labor felt quite real. The contractions came 5 minutes apart and were intense enough that I couldn’t sleep. The next day the contractions slowed down (more evidence of false labor I was told) and came 10 minutes apart. Still, the only sleep I could get was in between contractions. To make things more complicated, heartburn, which had been present throughout pregnancy increased and bordered on nausea, making it difficult to recline and hold down food and liquids. This meant that my tiny naps between contractions took place sitting up and at one point after trying to lie down, I did in fact throw up. Mark, my husband, caught me part way to bathroom on the floor vomiting. He sat ready with a towel to mop up. Much of this early labor he spent cleaning up behind me and trying to find foods that I would tolerate. He, not originally a fan of home births, was backing me in the decision and doing his best to support this experience of labor. By Friday, contractions were back to being 5 minutes apart. The doula recommended I get on hands and knees through the contractions. I did as she said, moving my back from rounded to arched (cat cow in yoga terms). I did this enough through day and night that my knees were sore and chafed. At 7pm on Friday evening at last my water broke. I was in touch with both my midwife and doula and still neither seemed in a rush. I found myself wondering more and more why this was still called pre labor. What threshold did I need to cross? In my birthing class I thought I learned that the length of contractions, the time between contractions and the intensity of contractions were the greatest indicators of my progress. I thought not being able to sleep was a sign they were strong and was surprised when the doula and midwife did not whip into gear. When my water broke I thought for sure this was a sign that baby would come soon. Doula and midwife still did not seem in a rush.
After my water broke, contractions came closer to 3 minutes apart. The doula finally said she would come in a couple hours. 4.5 hours later at 11:30 pm she arrived. Though I’d taken a birthing class, watched videos and read handouts on labor positions, the moment my doula saw me in a contraction she had some corrections. What I understood from classes and videos was that you were supposed to relax into a contraction. From many years of yoga practice what this meant to me was to enter into the pain and try to lengthen my muscles and spine, breathe and stretch through it. My doula on the other hand saw my body and told me I was avoiding the pain. She showed me how to use the pain, to move my weight down through the contraction. Not to lengthen but loosen down into it and to try to make the pain worse. This was significantly different than what I’d been doing and I wondered if I’d just wasted the last 2 and a half days by laboring wrong. What I understood through her physical corrections was that labor was really more about moving baby around so her head could put pressure on the cervix so that it would become effaced as well as putting pressure on the pelvis to make dilation happen and make room for babies head to descend. I had thought that contractions did the work of moving the baby and it was the job of the mind and body to relax and release so that the uterus could do its job. In reality it seemed that there was a lot I could do to maximize the effectiveness of contractions.
After several hours of laboring with my doula and moving in ways to increase pain, I was exhausted. I hadn’t eaten or slept much in three days and at 2am she encouraged me to try to sleep. Though I couldn’t fully sleep, the rest helped me regain some strength to continue. By 2:30am the midwife and birth assistant arrived. The midwife did an exam and found that I was 5 centimeters dilated and the cervix was 60% effaced. That sounded like halfway there to me and was a wee bit discouraging. As I continued to labor a new development emerged. I had to pee but couldn’t seem to go. I went in and out of the shower, sat on the toilet, tried going in the adult diapers that I began to wear after the waters broke but no more than a trickle came out. By early morning my bladder was full and a catheter was needed to relieve the pressure. This provided great relief but was also concerning because if I continued to not be able to pee, repeated use of a catheter could lead to urinary tract infection or worse, it could leave my body confused and unable to go after the birth. The midwife worried that continued reliance on the catheter would mean she would leave and I would be stuck with no relief.
The second complication crept up gradually. The waters that continued to flow from me were turning a darker color, a sign of meconium (baby poo) in my water which baby was breathing in while she waited to make her transition to this world. It’s dangerous for a baby to breath in meconium and if in high concentrations can lead to her having a respiratory infection. By 9:00am Saturday, meconium was becoming more concentrated. When the midwife did a vaginal exam I measured at 7 centimeters and my cervix not yet fully effaced. The team tried to get me to eat so I’d have some energy to continue to labor. I stared at a bowl of cereal, my doula who was an athlete insisted that I eat it. I’d had three bites and was pretty sure if I ate one more I’d throw up. Doula insisted so I ate. As predicted, moments later, it all came up along with all the other fluids I’d fought hard to keep down through the night. I showered again and then returned to the kitchen. The birth team was assembled and when I walked in, I noted the room got silent. “What’s next?” I asked. The midwife said she was concerned about a couple things. One was the meconium. If baby needed help getting the fluid out of her lungs, being in a hospital was safest. She was also concerned about the bladder and that there was no quickening of the labor in site. She wanted the cervix to be further along. By 10:30 am the midwife made the call to transfer to the hospital. I accepted that we needed to go but inside I felt discouraged, like my body had failed and now I’d enter the hospital domain where they would likely perform interventions like an epidural so I could rest and then Pitocin to speed me along. Though I was looking forward to my next catheter and understood that because of the meconium that this was the safest choice, I felt a little like we’d given up on my body and me.
By 11:30am my husband, doula and I arrived at the hospital and I was admitted. My midwife and her birth assistant did not come with us because of the inhospitable laws around home births in Maryland. When the hospital midwife did the vaginal exam on me she said, “You’re not going to believe this but you’re 8 centimeters and the cervix is fully effaced.” She was shocked because she said I wasn’t behaving like I was that far along. I don’t know what I was supposed to look like but at least she didn’t think I was in pre-labor. This did raise another question. If I didn’t “look like” I was that far along then and the transfer to the hospital happened in part because it didn’t look like I was progressing, was there a chance that I just look different then a lot of women? This wouldn’t surprise me given that I often feel like a migrating salmon going up stream in the rest of my life but in the context of labor where I chose a team that supports the most out of the box option, it was disappointing to feel like I was different.
I couldn’t tell what happened in the one hour from home to hospital that helped me become fully effaced and 8 cm dilated. Maybe I knew the hospital, this dreaded last resort, was going to make sure the process ended and that was on some level encouraging, perhaps simply getting dressed, packing a bag got my mind off of laboring and that helped, or the second emptying of the bladder (almost a liter drained both times) made room for baby to descend, or maybe I really had no control over anything related to the labor process and my body was just finally ready.
The hospital midwife made no mention of Pitocin or an epidural and I continued to labor in the hospital as I had at home. The hospital midwife, my doula, the nurse worked well as a team and there was even humor in the air. Around 2:00pm I started to feel what the nurse described as an “uncontrollable urge to push.” Another good sign. We tried several positions until we found one that seemed most fruitful. It was difficult to tell what was going on during the pushing. It was painful for sure and I wasn’t sure if I should push hard or soft, I could feel the stretch and imagined tearing. Though I had some control over my pushes, I smelled my bowels involuntarily empty. I kept asking if the baby was crowning yet and don’t remember an answer. I did know that we were close. Moments before the final pushes, Mark stood ready to catch the baby, I was poised to push at the next contraction, sensation was high when a nurse on the meconium clean up team arrived to share some details. Lying on my side, my legs open and body ready to push, meconium nurse began to share some procedures that seemed exceedingly important to her. I was bewildered and suggested perhaps we talk about this later. She said whatever it was she needed to say and stood back. I had predicted that if I ended up in the hospital that there would be moments where the variables such as this woman intruder were beyond my control. I continued to push with each contraction and in what seemed a relatively short amount of time (20 minutes), the babies’ head appeared. Or at least I could tell from Mark’s voice that something was at last happening. A couple more pushes and she came. It was 2:25 pm. I saw wiggling arms, legs and a little body perfectly formed. The midwife cut the cord. The cord was so filled with blood that there was a splatter. Unfortunately, the meconium nurse was hovering in a location where she found herself with cord blood spattered on her face. She was stunned and frozen for a moment. I was tired but I could have sworn the delivery team held back a snicker as she unfroze and the meconium clean up crew took the baby aside. Mark followed baby Evhe Simone to watch over proceedings. As they suctioned fluid out of her nose and mouth, she cried and coughed, doing her own fine job of aspirating her lungs. The midwife stayed with me to get the placenta out and assess the state of my body. Though I don’t recall this part, Mark remembers vividly that she described me as “a bleeder.” He was not encouraged by this descriptor, nor by the site of what seemed like an awful lot of blood. The placenta did come out a couple minutes later. Once Evhe Simone was cleared, she was placed on my chest while the repair job began on me, a little tear up and down required some sewing and a little tissue from the bag of waters lingered which made the midwife want to do a cleaning of the uterus. She called in the Obgyn on duty to do the clearing and then she did the stiches. Though anesthesia was offered. I saw no need. After delivering a baby, I imagined I would feel very little pain from a little stitching and clearing…. which turned out to be true.
Eve Simone was incredible; she came out perfectly formed and alert. She was eager to breastfeed and latched easily an hour after delivery. She had coughed and cried the meconium out of her lungs and required no serious interventions. After 3.5 days of labor we succeeded in a natural vaginal birth. I still don’t know why my labor was so long or if the notion that I have control over my body is a complete illusion but I do know that Evhe Simone is a blessing and is worth every moment.