It's been a while since my baby was born, but one of the other posters on the disabled Mamas' thread suggested that my birth story might be helpful to other women with orthopedic disabilities.
Medical background: I was born with hip dysplasia - actually, a dislocated hip - and had ten surgeries to try to correct it, ending with a total hip replacement. One of the surgeries created a "bony prominence" on the right side of my pelvis which extended almost to the midline. I was aware, going into my pregnancy, that this would create a substantial risk of needing a C-section. I also had surgery for scoliosis, which raised the possibility that I might not be able to get spinal or epidural anesthesia if I did need a C-section. I hated the idea of not being conscious for my baby's birth! So I swore I'd do everything I could to birth vaginally.
I saw an orthopedist for back pain during pregnancy, and he told me that "in this litigious society" there was "no way" I would be "permitted" to have a vaginal birth given my history of pelvic surgery. At that moment I was so grateful for my midwives, who, although they didn't soft-pedal the problems my pelvic surgery might cause, also told me that I deserved the opportunity to try for a vaginal birth. I am *sure* that OBs would have scheduled me for a C-section.
Leading up to the birth: Because the opening in my pelvis was so narrow due to the bony prominence, my midwife thought my chances of vaginal birth (which she estimated were under 50% anyway) would be better if the baby stayed small. I thought that wouldn't be a problem, because none of the other women in my family ever went to 40 weeks - they usually delivered around 37-38 weeks. I started to have a lot of prelabor symptoms and some bloody show in the 38th week, and at my 39-week visit I was 3cm dilated and 60% effaced. And then I stayed that way. For *two more weeks.* I tried EPO, I tried black and blue cohosh, and all I got was more prelabor.
Two weeks of prelabor had left me so totally exhausted that I was afraid I wouldn't be able to cope with labor when it came. I was also worried that my baby would get too big to fit past the bony prominence. So at 41 weeks, 1 day, we decided to try a Cervidil induction. I liked the idea of Cervidil because it would be reversible (they can just take it out), and because it didn't necessarily lead to a cascade of interventions the way that Pitocin would - I would be free to move around, get in the tub, wouldn't need a continuous monitor or an IV, etc.
The birth story: Because Cervidil can take twelve hours to work, we agreed to check in to the hospital on Sunday night. My mother arranged to come up on the bus Sunday afternoon. I spent the day resting, talking with my sister (in town for a medical conference), and cooking a birthday feast. After dinner, we had a chocolate cake topped with a zero-shaped candle, and everyone sang "Happy birthday, dear Alex." Then my husband Michael and I headed off to the hospital, leaving my mother and Barbara (our old friend and doula) at home.
They hooked me up to a monitor, and we discovered that I was already having mild contractions three to five minutes apart. We hung out for a while to see if they would intensify (they didn't), and then our midwife Kathy inserted the Cervidil and stripped my membranes. They kept me on the monitor for another hour, and then when nothing appeared to be happening Michael went home to get some sleep in our own bed.
The L&D nurse came in to check the fetal heart rate every hour. At two a.m., I was having strong enough contractions every five minutes that it took me a while to get back to sleep after the check. At three a.m., getting back to sleep was impossible. The contractions weren't painful, but they were definitely grabbing my attention. I got up to sit in the rocker for a while, listening to music and reading my book. Kathy came in to check me with her hand on my belly during a contraction at 5:30, and said they were "good and productive." At seven, I called Michael and told him to come back to the hospital with my mother and Barbara. The contractions continued to be arresting and mildly painful, but nothng I couldn't distract myself through.
My favorite midwife, Julie, came on duty at eight. At ten, twelve hours after the Cervidil was inserted, she did a vaginal exam. I had already noticed that the contractions seemed to be tailing off and getting further apart, and the exam confirmed that there had been little progress. The previous Wednesday, I had been 3cm dilated and 70% effaced. Now I was 4cm dilated and 80-90% effaced - not where I wanted to be. She gave us three options - go home and wait to go into labor naturally, try a Pitocin induction, or try breaking my waters.
We spent the next hour trying to decide what to do. Julie had said that sometimes when a pelvic anomaly made delivery impossible, the way it manifested was as an inability to establish a good labor pattern. So I was struggling with the question of whether I could give birth at all, not just whether I would give birth that day. I really didn't want to go home. Eventually, we decided to try breaking my waters - understanding that it would commit me to staying at the hospital until the baby was born.
Julie got me up onto the bed, which surprised me a little - I guess I had sort of been thinking of the bathtub. The bed was thickly covered with quilted cotton squares with waterproof backing. Having my waters broken felt just like a pelvic exam, mildly uncomfortable. Then it felt exactly like wetting the bed - a hot gush of fluid. Julie commented that there was a moderate amount of meconium in the amniotic fluid, probably just because the the bab was 41 weeks and therefore fairly mature. She walked us through the protocol for a delivery when meconium was present - suctioning right on the perineum, baby not encouraged to cry until thoroughly suctioned, no tub delivery allowed (which we hadn't been planning on anyway).
Ten minutes later, I was in hard labor. It was 11:15.
The strength of the active labor contractions startled me after the hours of mild early labor. I quickly discovered that I couldn't stay in bed for them - when the peak of each contraction hit, I wanted to claw my way to my feet. So I got out of bed and did some walking around the room. When the contractions hit, Michael and I held each other by the forearms and swayed back and forth in a slow dancing movement. Moving made the contractions somewhat less painful, but where it really made a difference was in allowing me to relax fully between them. I also found, from this point on, that I really wanted someone to pay attention to me through each contraction.
It seemed important to me to record each contraction, there at the beginning of active labor. They were coming three to five minutes apart and lasting 40-50 seconds, and I methodically wrote down each one for the next two hours. I think it helped me feel like I was in control, more than anything else - of course I can handle these contractions, I'm documenting them! - because there was certainly no doubt in anyone else's mind that I was really in active labor and progressing. I kept recording them until 1:30, when I lost interest.
During this period, each of my support people took turns going out to get some lunch while the other two slow-danced me through contractions. We also, eventually, got out the birth ball and I spent some time on that - rolling my hips in slow circles between contractions, and rocking back and forth during them. We played my mellowest labor CD again and again.
I hadn't realized how incredibly messy things would be once my waters were broken. I was leaking blood and meconium-stained amniotic fluid more or less continually. My support team did a phenomenal job of keeping me comfortable, constantly replacing the quilted pads I was sitting on.
Around in here I started chanting to myself something from my childbirth preparation book: "If you can cope through contractions and relax fully between them, you're doing very well. Do not expect to be able to relax during a contraction." I was still able to relax in between, even as the contractions became more and more demanding of my full attention. Somewhere in here a nurse asked me for my pain level, and I shocked Michael a bit by saying "seven." (I was comparing it to waking up immediately after major orthopedic surgery, which is my ten.) But they really did go completely away in between, which was the saving grace.
Julie was coming by every hour or so to check in on us. At one point she told us some bad news: the anesthesiologist coming on duty was the only one in the hospital who Julie didn't think was good, and was particularly unhandy with doing spinal anesthesia for women with spinal fusions. She wanted to know whether I wanted an epidural started by one of the better anesthesiologists - just placed, no medicine. I didn't want it, but I knew that I might be passing up my chance of a conscious birth if I wound up needing a C-section. So we decided to do another vaginal exam to check on my progress. I was 7cm. Also, the baby had moved down to between +1 and +2 station. Julie said cheerfully that she was now optimistic that I'd have a vaginal delivery, because the baby had moved so low. I decided not to have the epidural placed.
The endorphins kicked in somewhere in the middle of the afternoon, and I abruptly became cheerful and chatty between contractions. That was fun. I don't think it lasted very long, but by that point I had definitely moved into a different understanding of time - I couldn't say how far apart the contractions were or what I was doing between them. I felt like I was in an altered state of consciousness.
I drank ginger ale and chicken broth for a while, until I threw up, after which I stuck to water. I think the soda helped keep my blood sugar up towards the beginning of labor, but as the contractions became more severe I was nauseated with almost every one. Someone - Julie? my mother? - commented that throwing up was a great sign that labor was progressing. Ha.
I had asked Julie to start checking on me more frequently, every fifteen minutes. I don't have any idea when she stopped leaving the room and just stayed with me permanently, but she certainly took a more active role in directing my labor after the exam showed 7cm of dilation. She wanted me to try different positions: up on my knees in bed, leaning over on a stack of pillows. She followed me into the bathroom because I kept having contractions every time I sat down on the toilet, and she didn't want me to lose focus. When I started making a lot of noise with my contractions, she redirected the sound from moaning to a low, focused groan. (That helped, surprisingly.) She constantly reminded me to open up to the contractions instead of resisting them, and Michael picked up the refrain.
Finally she told me that she wanted me to lie on my side in bed. I was reluctant, because of how much the contractions had hurt in bed before, but she told me it was part of her plan to get the baby past the pelvic obstruction. My plan was to ask to go in the tub afterward, as a reward. Little did I know that there wouldn't be time.
Contractions on my side in bed hurt a lot. I groaned through them - it took every bit of concentration to get through each one, and in between I drifted off into a sort of a dream state. They were about four minutes apart, someone said in my hearing, and I realized with a horrible shock that I must not have hit transition yet. I kept expecting to reach a point at which the contractions hurt just as much but came right on top of each other - but instead Julie did another exam and told me that I was 9cm dilated. "But this can't be transition," I told her, "they're too far apart." "You can do transition any way you want to," she said soothingly. And in fact, it wasn't until the very last few transition contractions that they followed the "normal" pattern of following each other almost immediately.
"Do you feel like you want to push?" Julie asked.
"I don't know." I felt whiny and unconfident, is how I felt. This was the point at which I had the least belief in myself and the least strength. But I let her roll me over on my hands and knees, and on the next contraction she had me bear down a little. Surprisingly, it felt good even as it hurt. I didn't quite know how to push, but I could tell that it was going to feel better when I figured it out.
I spent two hours pushing on my hands and knees. In between contractions, I collapsed onto a stack of pillows on the elevated head of the bed. When the contractions approached, I struggled to my elbows to push. I credit the hands-and-knees position for my ability to have a vaginal birth - Julie picked it because she thought it would put the least strain on my hip, and it was certainly much easier for me to tolerate than I think any other pushing position would have been.
It was hard to feel how to move. Julie kept putting her hands inside me and stretching me, pulling violently (at least, that's how it felt) and encouraging me to push into her hands. As much as it hurt, it really helped to have a specific target to aim my pushes at. I would do four or five pushes per contraction, and then collapse and wait for the next one. Each time, the first push drew a yell of outraged pain - I think I was actually saying "Ow!!!" and then the others would just bring incredible strain. Slowly, the baby edged along. I started out with a cervical lip, a little bit of cervix that hadn't dilated - Julie held it out of the way with her fingers, and two contractions later the baby's head had passed it.
I was unbelievably hot. My hospital gown started out hanging off my shoulders, and then even having it touch my shoulders was intolerable. Michael helped me take it off. I couldn't bear the touch of his hands, because they felt so hot - so he spent a good hour and a half sponging my back, shoulders, and face with a wet washcloth and feeding me chips of ice. I have never, ever worked as hard in my life as I worked to push that baby out.
Partway down, the baby got stuck. There was a period of more than half an hour in which they kept telling me she would probably be born on the next contraction. I was dimly aware that the pediatric staff were standing by. I kept pushing, Julie kept pulling me open and stretching me, and it went on like that forever. I would feel her slip back in at the end of each contraction, which was *so* frustrating because I felt that I should be able to keep my muscles from pulling her back. At one point the baby's heart rate dropped enough that they put an oxygen mask on me. She kept almost crowning - the whole room was talking about her thick head of hair, marveling about how close she was - but she kept not coming.
"Michael?" I said, in a moment of silence, "maybe we should just adopt."
"I feel like the first two pushes are doing great, and then I lose my focus," I said. Someone in the background reassured me, but Julie said: "Your contractions are tailing off. We might need to give you a little Pitocin to get you through the last little bit." "I don't want Pitocin," I said. "I know you don't." So I resolved to push harder than I had ever done anything in my life. Michael - but fortunately, not me - heard Julie say to a nurse that if the baby didn't come in the next few minutes they would have to get a doctor.
And then, at last, I felt an unbelievable stretching pain and the head was through. "Suction," Julie called, and then more tensely, "Suction!" Then one more push and Alex's body came slithering out in a hot gush of fluid, and she was born. It was 6:21pm.
She cried while she was still on the bed, terrifying me and Michael because we were both under the impression that she was going to inhale meconium if she cried. But everyone else in the room was so obviously happy that I was reassured. They took Alex over to the warmer for more suction, and Julie helped me roll onto my back. It was truly startling, how quickly the pain just stopped once the baby was born. Someone put my glasses on, and I caught the first glimpse of Alex across the room. She looked, and sounded, pissed as hell.
My support team kept wandering over to look at the baby and coming back to see me with blitzed, delighted expressions on their faces. Everyone praised me again and again. I became aware, belatedly, that there were an awful lot of people in the room - I had only really been aware of Julie and Michael, with my mother and Barbara as a more distant chorus of encouragement.
Julie was having trouble delivering the placenta. She kept apologizing for manhandling me, pressing on my belly, but I was feeling no pain - just tremendous relief. Eventually she gave me a shot of Pitocin and the placenta came out.
"I want to hold my baby," I said a few times. I could see that they weren't working on her urgently anymore, but no one seemed to hear me. Then I looked directly at Julie. "Is there any reason why I can't hold my baby?" "No," she said, and immediately made them bring the baby over. They wanted to dress her first, but Julie told them she could be warmed on my chest. So there she was, in my arms for the first time. I held her for about forty minutes while Julie finished delivering the placenta and sewed up three superficial tears. She was utterly perfect. I couldn't believe that such a perfect and complete human being had come from inside me. When I brought her to my breast, she latched on like a little barracuda and nursed for almost twenty minutes. She was simply amazing.
I was high. I was floating on an endless wave of adrenalin and endorphins, calm and excited and completely unaware of any residual pain. I knew that it wouldn't be a good idea to get out of bed, and had enough sense to realize that I should take in some calories immediately, but other than that I was barely conscious of my body. Just my baby. Michael got me some soda, and then got a dinner tray. He fed it to me bite by bite so that I didn't have to put the baby down. He also spent some time holding her himself. We both made delighted, incoherent phone calls. "I can't believe I did it," I kept saying. "I can't believe I did it."
In retrospect, we made all the right decisions - breaking the waters, refusing the epidural prep, all of those things look like genius now because they turned out so well. I'm kind of sorry that I never used the birthing tub. I kept thinking that I would get into it when I felt like I was losing my ability to manage the contractions, and then I never got that way until it was almost time to push.
I simply can't say enough good things about my support. Michael was phenomenal. He stayed at my side continuously, giving me loving, caring attention. He did everything I needed him to do. When he got anxious, he managed not to show me. Barbara and my mother provided backup support to both of us, and the incredibly reassuring presence of women who had done this before many times. I knew both of them believed in me, and that helped me immensely. And Julie... I am one hundred percent positive that if I hadn't had her expertise and support, I would have wound up with a C-section. She was so calm and deliberate in her efforts to move the baby past the bony protrusion in my pelvis, and so supportive throughout. My mother had never seen a midwife delivery before, and was utterly amazed at both Julie's personal caring and her hands-on direction of my labor. I owe her my perfect birth.