The birth of Liam, birth of a Mama

Where to begin when the journey has been such a long one? It didn't start with Liam's conception... it was way before that. When Joe and i got married, we decided to start a family right away. We had been planning on using NFP to avoid a pregnancy, but when it came down to it, we realized that it was for other people's reasons, not our own. I wanted to stay at home and raise babies. And a few weeks after the wedding, we were pregnant. I was thrilled... it was all so new and exciting... those first kicks, i would lay on the couch and feel the flutters and marvel at the little one that was growing inside me. I decided that i didn't want to have an epidural because the idea of a needle in my back (or anywhere on my body) creeped me out. So i looked into Bradley classes and found a teacher for us. I was surprised with how she mistrusted the ob model of care. The more i got into classes, the less i was afraid of birth. Then, at 36 weeks, i found out that my little one was breech with her feet and her hands all up by her face. I didn't know of any doctors that did breech delivery and, honestly, i didn't feel confident pushing the issue. So i held out hope that she would turn or i would a c-section. One day at 38wks, 6 days, i started having strong BH contractions that were regular, so i went into the hospital and a little while later, our daughter was born via c-section. I came to terms with her birth knowing that next time, i would vbac.

When we got pregnant ten months later, i immediatly began researching homebirth. I was thoroughly convinced. I contacted a local midwife, and made an appt with the ob in the area that did back for the homebirth midwives. At my appt with him, i did the routine bloodwork and figured i wouldn't be seeing him again. A couple days later, the nurse from the obs office called, told me that i had an antibody (which i had no idea existed or what she was talking about) that it might be harmful to the baby and they had made an appt with a specialist in a month. A month. They told me that my baby was in danger and then told me i had to wait a month to find out more. I called Joe all panicked and he tried to calm me down and told me to call back and ask for the doctor. Turns out i had the anti-kell antibody and that my blood might attack my unborn child. I was terrified, knowing that my body might be harming my child.

The next few months went by in a whirl of tests, amnios, sonograms and mostly panic for me. But the baby was looking good and in my third trimester i started to believe that perhaps i would pull off my vbac after all. And i would not let myself entertain the thought that i might have to have another c-section. Because it was too scary. I couldn't go there again. My confidence grew, my belly grew and i started the waiting. Several times i had prodromal labor where the contractions would start, be regular but never intensify. Peter out. But it was helping me get ready.

Then at my 40 wk appt the sonogram showed i had hardly any amniotic fluid left. The options presented to me were to induce (with pit on my scarred womb) or another c-section. My doctor, who had a reputation for being very natural and patient suggested the c-section. My doula (who was also a homebirth midwife) just said, "if he thinks you should, then you should" I remember being so scared. Everyone else was happy that i was having the baby, that they had "caught it" in time but i didn't want it to happen that way. It felt so wrong. I chose the c-section. A billion times since then i have gone over that day in my mind. Should have hydrated better. Should have retested. Should have waited till the next day. Should have, could have, would have.... i tortured myself after the fact.

After Isaac's birth, i became depressed. I remember standing in the shower a few days after he was born, bawling my eyes out thinking that there was a reason God intended for the pain to be before the baby was born. He was high needs and i couldn't nurture him well. Joe had to step in and be the primary parent. I nursed him and tended to all his immediate needs, but he felt so foreign. It makes me so sad now, thinking of the time that i missed with him, the joy.

When he was a year old, i took a doula training and the healing began. After that weekend, i apologized to him for not giving him the birth i wanted for him and i came to terms with the fact that i made the best decision with the situation and support people i had at the time. And i knew that i would do things differently next time, my way, so that if i ended up having another section, i would know it was because i exhausted every other option.

In October of 2005, when Isaac was a year old, Joe told me that he would like to have another baby. My cycles came back two weeks later. It took me a couple of months (and the coming to terms with my last c-section) to come around, but in December, we conceived another little boy.

I was excited, but nervous because Joe was experiencing a lot of stress at work. Things calmed down and i settled into the pregnancy, with a bit of nausea but hope that this time things would be different. Joe is heterozygous for the kell antigen, meaning that our kids have a 50/50 chance of having it. Issy and Isaac both had it so i was due for one without, right? I made my plans and tried to find a midwife that would take me if i didn't have the antigen. At 19wks, we had an ultrasound and found out we were having another little boy (whom Joe named Liam Patrick) and we had the amnio to determine whether he had the antigen. Was it going to be a homebirth with a midwife and a nice stress free pregnancy, or were we going to go through the weekly sonos and stress and not knowing if the baby would be sick or well or have to undergo scary tests? Two weeks later, we got the results: Liam, too, had the antigen. And this was my second sensitized pregnancy, upping the ante.

I wanted to be conservative if the situation warranted it-- to have one foot in the midwifery model of care and one in the medical model. This proved to be difficult, but mostly doable. The first obstacle was the "due date" I knew when i ovulated... i am not stupid and i do pay attention. When i ovulate, i have a stabbing pain in the vicinity of my ovary and i have egg white cervical mucus. Not rocket science. And i knew when Joe and i were together. My babies are big, Isaac was 9lbs 6oz, so i wasn't terribly surprised when i was measuring big at my 19wk sono. They wanted to move my due date a week earlier, even though i knew darn well when i ovulated. So for the rest of the pregnancy, it was always "this is your 28 wk visit"... um, no, i am only 27 wks. It was monumentally frustrating. They weren't there when he was conceived, the machine wasn't there when he was conceived. Just me, Joe and God. The doctor and i basically agreed to disagree, but i knew when it came down to making decisions, that i was going to base it off my timeline and not theirs.

Liam was looking great, so good, in fact, that it made weekly sonos seem silly. So i started to go every other week and sometimes every two weeks. I wanted to continue this way until he proved otherwise that he wasn't doing as well. I was riding a fine line. I wanted these people to continue to care for me and to care for me in any subsequent pregnancies, but i also thought they were being a little overzealous. There were several things over the course of my first two trimesters that made me very wary about my care providers. But they were the best i could do, given my risk status. I still desired to give birth out of the hospital because i really felt like my doctors couldn't do what was best for Liam and I as individuals, because they were too concerned about covering their own behinds.

And so i started to plan an out of hospital birth. There were no midwives in the area that would take me because i was a vba2c, so we planned to do it ourselves. A good friend who was acting as a doula would be there. And that was the plan. I got a few supplies and wondered what i would do as the day got closer to him being born. I wanted to have him checked out shortly after he was born, to make sure he wasn't anemic, but i didn't want him to be treated overzealously because i had birthed him out of the hospital.

I went to my perinatologist appt on August 16th. She was very concerned. She knew i wanted to have a vba2c, but that i didn't want to be induced. I had also not seen my regular OB but a handful of times (because his care was basically redundant to the specialists care) I didn't feel the need to pee in a cup and have myself weighed at the OB's when i was going to be doing it at the specialist's anyways. She hugged me and told me she just wanted me and the baby to be ok. It was then i realized that although her and i had very different viewpoints about things, she truly was concerned. I had been maligning her in my mind, doctor= bad but it wasn't the case, she had just been trained in a very fear-filled model. I didn't necessarily feel on the same page, but i at least understood where she was coming from.

I had my sono and it seemed very evident that he needed to come out. The velocity of the blood through the cerebral artery was much higher than previously and definitely in the anemia range. The chart wasn't terribly accurate after 35 wks (i was 37) but it was the best we had to go on. And so we decided to induce. I had previously talked to my OB about a foley catheter induction, should it become necessary, and he said that was fine. So it was all set for the next morning.

A nurse called me a told me not to eat after midnight Yeah, i am going to do the hardest work of my life on an empty stomach. Whatever. I have read the studies and evidence totally doesn't support NPO so i felt safe to blow her off. That evening was hard... i really didn't think that i would end up delivering vaginally. The only reason i was doing it was because i wanted to be able to say that i tried it all and would go into the operating room knowing i did my best. I didn't want to have the "what if's" that i did from Isaac's birth. We got things ready at home that night, i snuggled my babies know this would be the last time i would just have the two of them. I had soooo much i wanted to do, i had just started nesting, but there wasn't enough time. My sister Michelle came over to give me a pair of longies she had knitted just for Liam. I was nervous and wishing he could just stay in a little longer. I got my wish... he wouldn't be born for two days

The night before

I didn't sleep much that night, got in bed late and got up early. Joe took some pictures of me... not exactly what i had hoped for, but good for rushed. We got to the hospital and it took forever to get things going. My sister (whose hbac i had doula-ed at four months prior) and my niece were there. My doula (and good friend) was out of town, attending a training. It was hard to be there, but good lessons for the soul. I had so hoped and prayed not to have to go to the hospital, but i had told Liam early on that i would do what i could do to plan a safe birth for us, and i covered my bases by setting things up at home and hospital and that he could choose. And for whatever reason, it ended up being at the hospital. They finally placed the catheter. It was fairly excrutiating. The doctor had never done it before, because usually the residents do it and let's just say, i considered giving up then and there. I wasn't dialated at all and only a little bit effaced and my cervix was very posterior, so it was hard to get to and then not knowing exactly how to place it equalled some serious pain for me. It finally got placed correctly and it didn't hurt. Which was good. Very good. I didn't start having contractions, which was no surprise, so i took a little nap, figuring sleep would be at a premium later. Boy, was i right.

About 2:00 that afternoon, i decided to try some manual nipple stimulation. They usually used pit to augment the foley, but i really didn't want to. So i figured, instead of artificial oxytocin, why not kick up some of my own? And it worked. After about an hour of nipple stimulation, the contractions were coming regularly on their own. It was encouraging. This was one of the many highs (followed by many lows) that came throughout Liam's birth. I started to have bloody show. My bowels were cleaning out. Intellectually, i knew things were happening i had put myself into early labor. I munched throughout the day to keep my strength up.

By that evening, the contractions were coming regularly and i was asking, begging Liam to bring them on. I told him it was safe, i was going to take care of him, i wanted to hold him in my arms and nurse him and make everything alright, if he could just cooperate. I decided that if i was going to be uninhibited, i was gonna have to get messy. I was tired of going to the bathroom, so i just put a chux pad beside the bed and want when i needed to go. Weird, i know, but freeing. I went through various stages of undress, trying to get in touch with what i might be doing had i been in early labor at home...

Going into the first night was discouraging. In my "ideal" birth, i had not wanted to be checked at all. I am a bit neurotic and i knew that quantifying my labor would not be good for me. I asked to only be checked at my request and then to share the information with Joe, so he could decide whether it would be encouraging for me to hear. Well, unforunately, the foley was a serious compromise to that. It encourages dialation and falls out when you are around 3 cm. Hours and hours of contractions (contractions i couldn't ignore because i was soooo focused on getting him out, that was my sole purpose those days) and it did not come out. The contractions were harder. I didn't know why i wasn't at three cm. I was sooooo discouraged. I remember asking Joe and Michelle, why isn't it falling out, i don't know how much longer i can do this. Having that damn catheter in was like having a neverending vaginal check, "nope, you're not a 3, nope, you're not a 3... still not a 3) It was horrible. So about 2:00 in the morning, we decided to take it out. What would happen? Would the contractions continue? Get weaker? I didn't care, i just knew i couldn't have that kind of reminder of what wasn't happening. It was such a mental relief. I was 2 cm and 100% effaced and he had dropped to 0 station. And now i could labor on and not have that lingering over me...

And labor i did... at some point that morning, i decided i wanted them to break my water. I knew that there is no real evidence about it shortening labor, but i was grasping at straws. Something, anything... Joe and i talked over all the options again and again, break water? little bit of pit? (nope) go to the c-section? But i kept having the contractions and he just kept getting lower and lower. I wanted to rest but i hated being woken up in the middle of a contraction. I felt disoriented, and it hurt much worse. Late afternoon, the contractions slowed and i took a thirty minute nap without a contraction.

Joe had been talking to our doula and she suggested some things to get it going again. After my nap i felt like i could go again. A little refreshed. So i asked the nurse for a breastpump to get things going. And boy did they. The breast pump put me into hard labor. It is kind of a blur from there. I was so excited that things were finally happening and freaked out all at the same time. I told you i am a bit neurotic, so while i had convinced myself during my pregnancy that UR didn't scare me at all, once i got into hard labor and the contractions were concentrated over my scar, it freaked me out. "this is it, uterus, time to see if you hold up" As the contractions picked up in intensity and duration and spacing (they were coming right on top of each other), i started yelling through them, panicked. Now i read birth stories where women say, "then i started vocalizing" and i wonder if that is what they meant? Cause i was pretty much yelling and it was very compelling. I couldn't not yell. I remember thinking about other women in the hospital and hoping i wasn't freaking them out and discouraging them from having a natural birth. I also thought about how i wasn't able to relax at all and wondering if i kept everything tensed up down there, if i could dialate. But it was just so intense, even though i was thinking i wanted to relax, i couldn't make myself.

Things get bad here. As i was white-knuckeling it through these contractions, my doctor hears me. I am thinking at this time that i was in transition, because they are one on top of the other and i am pretty sure that i can't do it anymore. So the doctor comes in. And this part is hard to write. I had a very painful and mightily discouraging vaginal check at this point. I was at a four (which was announced to the room) and the doctor apparently thought i should be more dialated. He thought perhaps there was another layer of water to break and that was what was "holding things up". So he tried to break my water again. It was very painful and pretty traumatic. Knowing that i was at a four, i told everyone that i couldn't possibly do this longer without an epidural. I felt so much despair, so sad, so tired, so disoriented, so discouraged. I wondered how i would lay still for an epidural. At one point before the anestheologist came in, i told my husband i wanted them to knock me out and give me a c-section.

I was screaming "O God O God" over and over and i told Joe that i never ever wanted to do it again. As the epidural was placed, i was praying that i wouldn't have any windows and that it wouldn't make my blood pressure drop. After it took affect, i feel into a deep but uncomfortable sleep.

I slept for about an hour before i woke up to Joe's snoring and bad heartburn. The nurse (who was very kind) asked me if i would like to be checked and i thought, "sure, now that it isn't excrutiatingly painful because i am numb" I was figuring i would have a c-section anyways, but my thinking was all muddled from exhaustion/distress i told her to go ahead. And i was at 5 or 6 cm and stretchy. I felt a glimmer of hope. I listened to Joe snore and i talked with Michelle. I was checked again and i was at a nine and my cervix "was melting away"

I was soon complete. The joy! How things had turned around from an hour or two before! It seemed like i might just pull it off! I labored down for a while. It was a good feeling. I could feel the pressure of each contraction, and i could feel the corresponding dropping lower and lower into my pelvis. It was so easy to visual how he was making his way down. I was feeling elated and excited i would soon make the little one that i had worked so hard physically and mentally and emotionally to get.

Getting ready to push

I had Michelle wake up Joe. He was disoriented. Last time he was awake, i was just falling asleep after my epidural placement and the torture that was. Things had turned around a lot while he slept. She told him to wake up because i was going to push and have the baby soon. I could feel the contractions and i started to push with them. I pushed when i wanted to push and the nurse stopped herself from counting and apologized, telling me that i was doing just fine on my own. I didn't push long, maybe 30 minutes. After having two c-sections, where they pull the baby out from behind a curtain and say, "here's your baby", it was such an amazing thing to watch him emerge from my body. I mean, i knew that my other two were mine, but there wasn't that transition, that visual bridge between womb and earth. Awesome.

And he was born. And holding him just moments after he was born, all wet and vernixy and fresh from the womb was the most triumphant moment of my life. I kept saying, "Liam, Liam, you are finally here, thank you"

More pics after he was born

He was born perfectly healthy. No anemia, no hyperbilirubinanemia. He was born at 37wks, 3days and weighed 7 lbs 12oz. Did we do the right thing inducing early? I have no idea... but i honestly felt like i was calling the shots. I did the research, when it got to a point where it seemed like he would be better out than in. It taught me so much. I hate that i got an epidural. I had been preparing for a natural birth for 3 and a half years But it was needed at that moment in time. And it humbled me. I feel like i can no longer monday morning quarterback other people's births in my head. Because i am not them, i don't know their story, their life that leads to the decisions that they make in birth.

There are things that i hate about Liam's birth. When the doctor tried to break my water a second time, he scratched Liam's head. We have a blood incompatibility and he bled inside of me. It could have serious reprocussions in later pregnancies in terms of the antigen. It haunts me. But there are many good things. The best being, i got to hold my baby, i got to birth my baby. So good. I so wish i could have had him at home. But he was born where we needed it. I truly believe that things happen for a reason. I am still trying to sort things out from his birth, to heal from the things that wounded me, to focus on the things that stregthened me. In the end, when i look at the pictures and my eyes are drawn to the surrounding things (like that i had to have a blood pressure cuff on) i just have to redirect my attention back to us. To the look on our faces as we first meet. And it makes everything else disappear. It is truly miraculous