Birth: Planned homebirth - hospital transport. 72 hour labor!  

Labor did not start easily for me.

  Because of pre-term labor stuff I'd had at 33 or so weeks, I thought maybe I'd birth early - 37 weeks sounded good to me. Then 37 weeks arrived...and passed. And 38 weeks, and 39 weeks. I could tell that things were changing in my body. Every day I felt closer to labor, but I still didn't know how far I had to go before labor would start - the kind that would lead to this baby being born SOON.

  Fortunately, I started feeling better each day too. I started taking walks each day again - Meg and Wendy traded off taking me out for my bedtime walk each night. The extra energy was nice, but not really enough of a trade off for all the waiting and of course, the aches and pains of the 9th month of pregnancy!

  Forty weeks passed. The questions and phone calls from well meaning friends and relatives kept making me go ballistic. I stopped answering the phone. I hated going into the office. NO, the baby WASN'T born yet. YES, he IS HERE, just inside me still. "Patience is a virtue" I kept telling myself.   By 41 weeks, I was doing lots of the folk remedies for inducing labor - walking, blue cohash, PN6, nipple stimulation, orgasm, visualizations, talking to the baby, accupressure points, accupuncture, and probably more. My birthing tub had arrived at 39 weeks, and was slated to go to the next woman in the next few days. My family tried to be good, but their patience was wearing thin too.

  At 41 and 1/2 weeks I had had it. This was it, I was going into labor NOW! My midwives prescribed homeopathic blue cohash every 1/2 hour for 2 hours. No labor. I went to bed. Sunday morning I started taking blue and black cohoshs alternating every 2 hours. I upped my dosage of PN6 to the maximum. In the evening, I let Wendy do raiki on me. Anything, if it would work! There she was, standing behind me waving her hands around and laughing hysterically. I wish we had a picture. She claimed that the baby was feeling a bit "sluggish" and told me to drink a mug of ginger tea. Yuck - it tasted awful but I drank it anyway. Half an hour later I was sure - these were labor pain! Not too strong yet, but definitely labor pain.

  By 11 pm, my contractions were pretty regular and getting stronger. They were 5-10 minutes apart, lasting 40-60 seconds. I was pretty excited! Finally! We called the midwives to let them know that they would need to arrange child care soon. They told me to rest as much as possible. I thought they were nuts, though I knew that they were right. My contractions seemed much too strong to sleep through. I spent the night charting my contractions while Meg or sometimes Wendy kept me company. We noticed later a curious pattern - every time I was alone or with just one, very CALM person, my labor speeded up. It was amazingly difficult to remember this. It wasn't that I didn't want the other people (though sometimes I didn't), but more that my body had its own agenda about this process.   Morning came, with birds starting to sing long before dawn. I was still laboring, and beginning to wonder how much I had progressed. My mother birthed me, her firstborn, after just 3 or so hours of active labor. My body had been preparing to start labor for so long that I thought maybe I'd have a short labor too. It was a stretch for me to imagine - I'd always for some reason thought I'd have a long labor - but I wanted to be open to the possibility too. I had been contracting pretty strong for some hours and it was getting harder to imagine how much longer I could handle this. We called the midwives, and Gretchen showed up sometime after dawn. She checked my cervix. I was 1-3 centimeters dilated. She could feel the baby pretty high up, and his head bones were starting to mould. I took the news pretty calmly. Everyone kept waiting for me to get depressed. It didn't happen.

  I spent the whole day long laboring. Kim and Gretchen stayed close all day. We kept most of the household at bay downstairs. I loved being home and the quiet, beautiful space I had in which to labor. I worked HARD. My midwives kept close tabs on my blood pressure all day. It kept going higher when I was sitting up, so they encouraged me to lay down on my left side, or stay in the birth tub (which I still had). I knew that if it went above 140/90 then we'd have to go to the hospital. Kim and Gretchen kept the family updated on my progress, and discussed the possibility of a transport. It was clear by now that I wasn't going to have a FAST labor! We hypothesized that the baby was having a hard time fitting through my pelvis, or maybe he had a fist up beside his head. Clearly something was slowing his progress, and it WASN'T my work.

  Late in the afternoon, Gretchen checked me again, and I was 7 centimeters dilated. They kept waiting for me to get really excited. It didn't happen. I was busy and tired! The contractions were stronger and I was really using my support people to get through them. Breathe in through my nose, out through my mouth. Stare into my midwife's eyes and deliberately relax through the pain. Don't think about the next contraction - just get through this one!   Then my blood pressure started to go up even when I was lying down. My midwives have a theory that the top number of the blood pressure indicates that stress on the mother. The bottom number indicates how the baby is doing. So, even though his heartbeat had been rock steady (good numbers, good variability, etc.), they were concerned for the baby when my bottom number was up in the 80s and even 90 while I was lying down. They told me that we needed to go to the hospital. Apparently, even then, my midwives had a feeling that something was difficult for the baby. They thought maybe it was meconium in his lungs.

  This was the end of my vision of a homebirth that I had fought and planned for for many, many months. Again, I didn't feel much. I had midwives that I could trust with this decision - I KNEW that they wouldn't be making this choice lightly. They were just as committed to a homebirth as I was - but even more we all wanted it to be a GOOD birth. Safety was paramount. So everyone ran around the house madly packing. Before long we were all (the ENTIRE family, and both midwives) packed into the cars and headed to the hospital.

  Half way there, when we were stopped at a traffic light, I suddenly felt this big bump. We had been rear ended! We hit the guy ahead of us but I don't think his car was hurt at all. Everyone was swarming out of cars saying "We've got a woman in labor and we've got to get to the hospital!" I just sat there looking pathetic with tears streaming down my face. The tears were for the lost homebirth, not the accident. I think that confused a few people but I didn't care. I didn't feel particularly bad, I just needed to cry.

  Finally we got to the hospital and got checked in and settled in a room. The nurse assigned to us recognized us as a homebirth transport but was very supportive. I knew that we might very well face prejudice from the hospital staff, so I was glad to cross that worry off my list for the moment. However, when she checked me I was only FOUR centimeters dilated, and it seemed that the baby had moved back up a bit. Generally, the labor and delivery nurses believe that no one can UNdialate, so they don't really believe that I was actually at 7 centimeters Monday. My blood pressure was still high by my midwives standards but was just fine by the hospital's standards. We tested my urine, however, and I was spilling ketones big time. That meant that my body was showing fatigue. I was also dehydrated, though mostly I had been doing a good job of drinking and eating. The nurse gave me the option of trying to hydrate on my own or getting an IV. Being me, I of course choose to try to rehydrate on my own. So I drank, and I drank, and I drank. My ketone level went down. I drank more. I threw up. Sometimes that helps labor progress, so even that wasn't too bad. However, when the nurse checked me again (and boy was she rough about it!) I was still 4 cm. She said that since I wasn't progressing that we really should try the IV. And so it was.

  I haven't been an inpatient at a hospital since I myself was born. So this experience was full of firsts for me - my first IV, my first catheter, my first official wheel chair ride. How exciting! (hear sarcasm)   The nurse missed the vein on the first try, but got it on her second. I got a whole bag of basic IV stuff dripped into me, but I still did not progress. By the middle of the night (Monday night/Tuesday morning) I was exhausted. I was sleeping between contractions for awhile but it wasn't enough. I had been up for 42 hours. I wasn't quite at the end of my strength yet, but I wasn't going to make it through pushing without some rest. Once again I had to decide what to do next. First I asked Meg to stay with me and listen to me cry for a bit. Things had been pretty hard! She had to chase maybe 4 or 5 people away just to get 15 or 20 minutes of quiet time with just the two of us. No wonder it had felt like a constant challenge in the hospital to maintain that kind of quiet space where I labored best! Fortunately, the hospital staff was quite respectful when Meg explained that I thought a good cry might help labor along.

  I decided to have a shot of intermuscular morphine and to get some rest. It made me really sleepy really fast. Meg was glad of the rest too - the rest of the family had been sent home but I made her stay with me. We slept for almost 6 hours.

  The next day was more of the same. I labored most of the next day, from about 9 am to 6 pm. Still no progress, but once again I reached the end of my strength. I remember laboring in the bathroom, where I could use the bar on the other side of the bathtub to hold during contractions. Every time I closed my eyes I started to dream. Even if I only had my eyes closed for a few seconds, I'd start to see few dream frames. I started to talk in my sleep, which really amused Wendy and Meg. I was even dreaming DURING contractions. I was tired! I had more morphine, but only got about 3 hours of sleep before the contractions woke me up. A friend of mine who is a chiropractor called and offered to help. We accepted. She came down and gave me an adjustment. Meg said I was a poster child for chiropractic - the before and after was incredible. We do have one picture from after, and I think I look AWFUL, but I guess I looked even worse before! Even with that help, I only managed to labor about 4 more hours before I needed help again.

  This time I chose the interthecal morphine. This is similar to the epidural, but as far as I can tell it is superior in many ways. It is injected into a different part of the spine, but I still had to sit still and hunched forward for about 5 solid minutes. It is a single injection, so I wasn't hooked to anything. Morphine is very pure drug, and I hear that it is one of the easiest on both mom and baby. It also leaves the body relatively quickly. I DID NOT like the way it felt going it. It felt like fluid was being forced into my spine via a needle. Surprise, surprise. But after a little while my belly and back stopped hurting during contractions. What a relief! I went to sleep with a plan (and a doctor's order) for pitocin when I woke up.

  I was pretty worried about pitocin. I had heard that pitocin contractions were much sharper and harder to deal with than non-medicated contractions. I think that is why I waited so long to try it. In retrospect, I should have tried it earlier. Of course, with the morphine in place, the contractions felt like pressure, but didn't really hurt, so the extra kick from the pitocin wasn't really a problem. Amazingly enough, on the pitocin I dilated from 4 cm to 10 cm in about 4 hours - between 11 am and 3 PM. The interthecal morphine shot, which was supposed to last between 4 and 10 hours, lasted me almost 12, only wearing off just as I started to push. Transition didn't seem like much of a big deal. I had come to the end of my rope so MANY times before! The contractions had gotten much stronger and felt like a whole LOT of pressure on my pelvic floor. I think this is when I got my first catheter. Yuck - it felt awful going in. Gretchen couldn't believe how much urine I'd stored up in my bladder. It came out, and out, and out. Boy, that felt good.

  I started to feel the urge to push. My memory of this part is a bit more fuzzy than the rest of my labor. Gretchen called Kim, who had popped home to check on her family. She told her to come quick. They helped me get settled on the bed in a good position for pushing. I DO remember the nurse grabbing my hand and putting it where she wanted it. I was APALLED, and pulled my hand away. All she had to do was ASK. Meg and Kim tried to explain. Kim looked me in the eye and told me what I needed to do. I did it. I started pushing. Gretchen told me that I was going to have to push harder. I couldn't imagine how I was going to do that!

  Now that I'd started pushing, Meg decided she'd better get the rest of the family here QUICK. After all, the baby could be here any minute now! After watching both Jeremy and Claire all day Monday and Tuesday, Bonnie had finally sent Jeremy to school, Claire to day care and herself to work Wednesday. I was really grateful to have fewer people around me WAITING for the baby to be born. However, now they all had to be fetched. Dr. Plesants, my own doctor who'd I'd seen for my western prenatal care, was finally on duty. I wondered to myself if I'd planned it this way - laboring all this time just to wait till my own doctor was there to catch the baby! Apparently Dr. Plesants was there quite a bit, but spent a lot of time down in the lounge with the rest of the family. He scores points for that - I really DID NOT need more people in the room with me.

  In the meantime, back in my room, Kim and Gretchen were coaching me through push after push. I sure had the urge to push, but pushing harder HURT. They kept me relaxing between pushes and pushing hard during contractions. Slowly, slowly, the baby moved down. Like the rest of the labor, it was slow but steady progress. I'd started to push somewhere between 3 and 3:30. At 5, Dr. Plesants came in to say that he had another commitment and would be leaving when his shift ended at 5:30. I pushed even harder, but they weren't even seeing the baby's head yet, so I had to accept that he would miss the birth.   Shortly before 6 the new FP doctor came in, Dr. Cathy Dolan. Gretchen looked at her and said, "Cathy Dolan??" It turned out that they had known each other as children but hadn't seen each other since then. That was pretty neat, but I finally snapped at them to shut up and pay attention to ME until I finished the next contraction! Dr. Dolan turned out to be a gem. Mostly she sat STILL in a chair at the edge of the room.

  I kept pushing. It hurt worse. Kim and Gretchen had their hands in my vagina almost constantly smoothing and stretching it. We had filled a whole peri bottle with almond oil, and Meg kept squirting it on their hands. My midwives have never learned to stitch tears - that is how committed they are to avoiding tears. They noticed that when they had their hands in me I pushed more effectively. Eventually Dr. Dolan and the rest of the hospital staff started worrying that I wouldn't be able to push this baby out vaginally. After all, it had been 3 or 3 1/2 hours already. Apparently Kim and Gretchen HAD started preparing my family for the possibility of a c-section, even though they thought I wouldn't need one. At the same time, I was pushing harder and harder. I knew that I simply could not give up. That was not an option. The baby HAD to come out, and the only good way out was through my vagina. I developed a mantra - "I'm going to RIP this baby out of my body." That is what it felt like - pushing so hard to where it hurt that I would rip myself open. It was very hard.

  We tried different positions. The best was the birthing stool that the hospital had. I stayed on that for almost an hour, even though I got all swollen up from staying in one position. Moving around really hurt, and later, it was very strange. I haven't heard any other women talk about walking around DURING the pushing stage - while there was a head between my legs right at the entrance to my vagina! It felt just about like you'd think it would to walk with a head keeping your legs open. Very strange.

  Finally, Dr. Dolan got worried. She thought there might be more problems than she could deal with, like a stuck shoulder. She called in the OB resident, Dr. Beard. When he was told my story, he immediately told them to prep me for a c-section. Apparently Dr. Dolan headed him off, and got him to come see me first. I remember them telling me that I had 20 minutes more. I guess the threat was a c-section if I hadn't made enough progress. A deadline like that wasn't a bad idea for me - I pushed harder than I ever thought I could, knowing that it WOULD end. I guess I made enough progress. They were definitely seeing the baby's head. Gretchen wanted them to do a episiotomy, the first time in all her years as a midwife that she has recommended that. Dr. Beard wanted the baby out quickly, and decided to use a vacuum extractor too. There were too many people involved, and things were happening too quickly to really debate the issue with him. I think that is when the baby's heart rate started to go up, into the 180-190 range. They got a little panicked!

  Dr. Beard got set up and they dropped the end of the birthing bed and put up the stirrups. Now that pushing wasn't that important, I could really notice the contractions and I HAD to push through them. I had really lost track of what was a contraction and what wasn't, since the pushing I was consciously doing was so much stronger than the involuntary contraction. Dr. Beard injected me with some local anesthetic and prepared to give me an episiotomy. I didn't really feel the cut, or the much longer tear than came afterwards. I guess the local really worked. I also couldn't feel the vacuum extractor, so it was really cool to see a picture of it. About this time a bunch of loud, excited people came into my room, on the other side of the curtain. It was the baby's team. I'm glad they were there, but they were too excited to be sensitive to the energy in the room, and that was too bad. I think there were about four of them.

  Back in my bed, I gave several more BIG pushes, and FINALLY I felt the baby's head pop out. Another push and I felt the rest of his body slide out too. They had put a receiving blanket out on my stomach, and they laid him out on it right away. His feet were toward me, and I put out my hands and got to feel his slimy body. We have one blurry photo of this. In the next minute or so, Dr. Beard cut his long cord, and determined that he was breathing too fast. I bet they also saw the problem with his lung - we can see a bluish patch in the photo. Part of his right lung was collapsed. They whisked him away to the warming table and his team on the other side of the curtain. There he was fairly roughly toweled dry and stuck with a variety of tubes. Kim got me talking to him amid this chaos, and Wendy inserted herself right next to him. After a few minutes, maybe 10, they brought him over to me all wrapped up in a blanket. I got to hold him for just a few minutes before they sent him off to the nursery. There was only one tag for someone to go with him, so I chose Wendy, who had been getting sleep these last days, and was going to be a great ally for our new baby.

  Despite my promises and wishes, the kids and Bonnie missed the actual birth. Things happened too fast to get them, and Meg said that she figured that if she ever managed to get around all the people to get OUT of the room, she wouldn't be able to get back IN again. I counted, and I figure that there were 13 people in my small room when the baby was born. I'm kind of glad the kids missed the actual birth. I think that it is wonderful for kids to see "natural" births, but seeing very medical births is another thing. They came in right after and got to see the baby before he left, and again through the window in the nursery. Wendy stayed with him ALL night long, through the nursery, and then into the NICU (newborn intensive care unit).

  Meanwhile, back in my room, Dr. Beard delivered my placenta. I was surprised that it came out so quickly, about 5 minutes after the baby. It just slipped out too - I guess we'd made quite the hole. Then I started hemorrhaging. Kim said later that blood was pouring out of me like water from a pitcher (and she demonstrated with my pitcher of water). They had already upped my dosage of pitocin in my IV and that wasn't working. The nurse went to get a shot of methergin. Kim looked me straight in the eye, and said "Toby, you have to make your body stop bleeding." I looked back at her and said in disbelief, "How??" She replied "Just tell your body to stop". So I did, and by all reports, my body responded and I stopped bleeding. Then the nurse injected the methergin, and that crisis was well and truly over.   We still had quite a bit of repair work to be done. Apparently I tore quite a bit after the cut. My legs were still so shaky that with my feet in the stirrups, I still needed help to hold my knees up. My legs were shaking like they do when I have just spent quite a while on a rock face and I get "sewing machine legs". Then the nurse got me and the bed cleaned up. I was SO tired. Anyone in the room with me kept rehashing the birth, and reports kept coming in on the baby. Kim examined the placenta and pronounced in old and fragile. I told everyone about the new lilac we had waiting at home to plant over the placenta. (Our miscarried baby is under a peony, and the cat is under the tulip bed). The nurse then claimed the placenta and carried it off to test the cord blood for something. We are still trying to get the placenta back from pathology.

  Wendy, Jeremy, and Claire all claimed that now that they saw him, the baby was definitely an Adam, like I had been insisting for months. I waited my final approval until I could really see him the next day. Dr. Beard headed out, after telling me how impressed he was with my work and the birth. That meant a lot to me, and maybe in the future he will have more faith that birthing women CAN do more than he thinks!   As time passed, the fatigue got worse. I told Gretchen that the distinction between dreams and real life were starting to blur again. Yes, I knew which was which, mostly. I asked Meg to stay again, and just before sleep I started cataloging the experience: Almost three days of labor, 5 hours of pushing, tons of drugs, episotomy, baby born with collapsed lung, now in NICU. Just the birth I planned, right? I started laughing hysterically, but had to stop because it hurt too badly.

  Thursday morning I took the time to bathe and get rid of the catheter before I headed down to NICU. When I was wheeled to his spot, Meg was holding him and Dr. Buchner was visiting. All of a sudden I needed that baby NOW. I started crying. They handed him to me and the rest of the world ceased to exist.

  He was attached to lots of monitors, but he was doing fine. Earlier in the morning they had given him more morphine and then used a very fine needle to extract the extra air in his chest cavity. The procedure was a success and his lung had reinflated. He was breathing better now, but they were still watching it closely. His IV attachment covered one arm from fingers to elbow. I was surprised at how fair his skin was. He was peeling all over. Apparently that is a typical thing for post dates babies. He had been sucking on a pacifier, which helped him not cry. Crying was hard on his lungs at this point. The nurse got me set up with him on my lap and he latched on right away and started eating. I found the position pretty awkward, but it worked.

  The rest of our stay in the hospital was more mundane. I tried to get down to NICU every 3-4 hours. I usually ended up staying 1-1 1/2 hours each time. The staff there was fantastic. They are completely committed to breastfeeding, and gave him nothing but the IV and the pacifier. The NICU has its own lactation consultant, though most of the nurses were quite knowledgeable too. I was surprised at how calm, and quiet the NICU was. I had heard stories of other hospitals with bright lights and lots going on. I knew that that was dumb for newborn and preemie babies, so I was glad to relax into good care instead of having to lobby for better conditions. The staff was quite curious about our family, as we had been pretty open about it. By morning, Wendy had managed to get the records changed to reflect Wendy, Meg and I all as parents, even though that was a stretch for them. That also made our stay quite a bit more comfortable.

  Overall, I was just thrilled with the staff at The Birthplace, the birthing unit of Fairview Riverside hospital. It feels a bit funny for me to rave about hospital staff, but they deserve it. Overall, I also feel that I got the best birth I could have had, given Real Life. Part of that was due to the hospital staff, but even more was due to my family and to my midwives. This was the second really hard event that these midwives had seen me and our family through (the first was my miscarriage). Both times, I was left feeling that I had experienced something really hard and really wonderful. I was able to notice my own strength and the power of my own body. I actually managed to USE the support of other people to help me with the pain. I have suffered from bad menstrual cramps periodically since I was 10. I have never been able to really notice and use support from other people during these times like I was able to during my two labors. I've always wondered if labor would be worse than menstrual cramps. Now I know - aside from the pain of pushing, there wasn't a 1 1/2 period in all of my labor that was as bad as the menstrual cramps I get. That is how bad that pain is!

  I also know, without much shadow of a doubt, that I managed to stay at the lowest level of intervention possible at every point of my labor. Part of that was my determination. Much of that was my planning, i.e. having skilled midwife support. Regardless, I'm proud of myself for getting the best birth I think that I could have had.   Adam and I were released on Saturday, April 25. Now, almost 2 weeks after his birth, I am still recovering. He is nursing like a pro after a bout of dehydration after we got home. Sometimes he sleeps 4 hours in one stretch at night, but 2 1/2 is more common. Today I am hoping to take a big outing - a walk around the block. The spring weather has been incredible and I've been missing it.

  I am so glad that my little Adam (which means earth, and who was born on Earth Day, with an earth sign despite having a fire sign for a due date) has joined our family in the big wide world. I'm NEVER doing this pregnancy and birth thing again! _