Those who know us know that Violet spent 48 hours in Tampa in the NICU after we were released from the birthing center. I will cover that experience in my next entry, but it's important to me that everyone knows that her complications had nothing to do with her being born in a birthing center. If we had been in a hospital, not only would the same thing have happened, but they still would have transported her to Tampa, and I would have been unable to go with her, as I would still have been a patient and would not have been discharged. Being in a birthing center kept me with my precious new baby in that horrible situation- I don't know how I would have survived it otherwise!
When I got pregnant with Violet, I fully intended to use the same ob/gyn, the same hospital, I would still get the epidural, but this time it would work and not run out for an hour of transition and three hours of pushing. The one thing that I knew I wanted to be different was that I wouldn't allow the doc to induce early for no reason. But- I remembered the pain of the contractions before the epidural. I knew I needed some breathing or focusing techniques to get me through to the epidural. So I bought a Lamaze book. It changed everything for me! All of a sudden, reading about natural childbirth, I realized that EVERY problem I had during Charlotte's birth, every single thing I hated about the experience, was due to drugs- the induction and the epidural. Those problems followed us long after her birth when she wouldn't breastfeed. Looking forward to Violet's birth, I realized that it was necessary to avoid any unnecessary medical interventions if I wanted to have a less traumatic birth. This seemed shocking to me: I was going to have to put my body through the worst pain imaginable for it to be less traumatic. But it's true.
Charlotte was induced at exactly 39 weeks. This was done for absolutely no valid medical reason. The doctor asked if I wanted to wait to go into labor on my own or schedule a time with the hospital to have her. I was worn out with being pregnant and just didn't want to do it anymore. No one told me there were risks to an induction- that I was more likely to have a c-section, that you're forcing your body into doing something it's not ready to do, that pitocin makes for stronger contractions, that you increase the risk of distress to the baby, that you will be given drugs expressly forbidden in pregnancy. I never looked into it and agreed to the procedure.
I checked into the hospital on a Thursday morning, January 22, 2009, when they spent the day ripening my cervix with a drug called Cytotec. I found out later that Cytotec is actually quite dangerous, and has been linked to fetal and maternal death. The manufacturer says not to use it for inductions. 24 hours later, they started pitocin. The contractions were so intense that Charlotte pooped in utero, something not at all uncommon during induction. I got an epidural at 4 centimeters that wore off for the last four hours of labor. But even though I could feel everything and easily move my legs, I wasn't allowed to move off of my back to make pushing easier. I ended up pushing for three hours, before delivering via vacuum extraction. She was born at 10:03pm, they cut the cord immediately and took her from me to be suctioned for meconium. It would be almost a full 30 minutes before they gave her to me to hold for the first time. They had already done her eye antibiotic and bundled her- I didn’t get any skin to skin time with her. It became evident at the very beginning that she wasn't nursing well. She could latch very well, but couldn't suck. Bottles were the only way to go, because they dripped and didn't require work on her part. I know now that the combination of a sore throat from the suctioning for meconium, the sore head from the vacuum extraction and an immature suck-swallow reflex from being early are responsible for her poor sucking. I regret every day that I was not able to nurse her. I was going to get it right the second time.
I was 36 weeks pregnant with Violet when I panicked. I couldn't birth in that hospital again, even naturally. I had been around and around with my ob/gyn about certain policies, especially about IV fluids. The hospital does not allow women in labor to eat or drink at all, therefore they put you on IV fluids, something that can make moving around harder and can interfere with breastfeeding because you can get so waterlogged. She wouldn't hear of a heplock instead. This makes no sense to me. The rationale is that if you have to have emergency general anesthesia, you can aspirate your stomach contents. But it's rare to be generally anesthetized, and rarer that you would go under without them protecting your airway. If you were in a car accident on the way home from the buffet, they can't operate because you have a full stomach?? Anyway, my ob seemed to have difficulty understanding why I wanted what I wanted. That in combination with her inducing me with Charlotte (a highly questionable decision), the use of Cytotec, and the memories of that ward made me want something different. Something better.
I first called a homebirth midwife. After our initial conversation, she said I was a good candidate, but upon reviewing my records, she had to deny me. I have Mitral Valve Prolapse, a very common, completely harmless heart “condition.” She was not comfortable with this- and I appreciate it. I don’t want someone taking chances! I did cry for days after that, though. The midwives who deliver at the hospital in Ocala would not take me so late in my pregnancy. Finally, I found The Birth Place in Orlando, who agreed to take me so late, and besides a little concern about making it in time during labor (it’s a 90 minute drive), I was overwhelmed by the staff there. It's such a comfortable environment. The midwife, Anne, reassured me over and over with her trust in the process. I was pretty sure this was something I could do. There would be no IVs, no continuous fetal monitoring, no restrictions on eating, drinking or moving around. They would delay cord cutting, and delay eye antibiotics until breastfeeding was established. There would be very few internal exams. I would be carefully monitored, the baby would be carefully monitored, and if any serious complications arose, the midwife is well trained and equipped to practice life-saving techniques before a transfer to Winnie Palmer Women and Babies Hospital would be arranged. Birthing is not a disease. In a healthy, normal pregnancy, your body knows what to do. I find the birthing center option to be much safer than the risk of interventions in the hospital.
Violet was due on August 18. Being pregnant during the hottest summer on record (I don’t know if that’s true, but it sounds right!) is the worst. But I refused to take medical intervention to end this pregnancy. You take one thing, and before you know it, you're flat on your back in the hospital bed unable to participate in the birth of your own baby. For 14 days before I went into real labor, I had contractions every day. They would get close together every night, then disappear in the morning. They got increasingly more painful. I was getting upset at all the starting and stopping, and the contractions would very much interfere with my sleep.
On Wednesday the 24th, I was up all night with contractions that were 7-8 minutes apart. At 6am, my husband decided to call in to work, and we headed to Orlando. My sister lives 10 minutes from the birth center, so we figured that we should head there while I was still comfortable. When we got there, my contractions stopped. Fully stopped. In the afternoon, we headed to the birth center for a scheduled check-up to find I was still 1 cm. Anne sent me to Winnie Palmer for a biophysical profile since I was almost a week overdue. Then she said to head all the way home and rest. The profile showed that the placenta was in good shape, the amniotic fluid was abundant and baby was moving well. We drove home.
The very next morning, I awoke with contractions 2 minutes apart. At 3 am, off we went again to the birthing center. All the way in Orlando. Again. By the time we got there, contractions were happening less than every 10 minutes. We agreed to go to my sister's and wait it out. Jason and I agreed that we were done driving back and forth. We weren't leaving Orlando without a baby. My parents were home with Charlotte, and didn't mind keeping watch on her.
The next morning, Friday, I was in terrible pain. My bladder hurt me so badly and desperately that I could barely stand or change positions. It was constant and unrelenting, accompanied by an overwhelming urge to pee that I couldn't satisfy. I would pee, stand up and immediately feel the urge to pee again. I told Jason that the pain was so unbearable that we needed to get checked out. I called Anne and told her we were going to head back to Winnie Palmer to see if something was wrong with my bladder. We arrived at Winnie Palmer at 12:30 and waited and waited and waited in triage. There were so many people there that we had to sit in the hallway. I continued to have contractions there. At 4:30, after an hour of tracking, we discovered that contractions were 4 minutes apart and steady. I called Anne, and she said to come in. So after 4 hours of waiting, we split the hospital. I thought about how bizarre it was to be standing in front of a hospital that delivers 12,000 babies a year in full-blown labor, waiting for Jason to get the car so we could go somewhere else. Isn't it always the other way around?
We arrived at the birthing center right as another baby was being born. Anne saw us in good time, and happily told us that I was at 4 cm. Finally!!! Real labor had begun. She and Shannon, the birthing assistant, settled us in to the Van Gogh room, decorated in Starry Nights. It's a comfy room- a large (real) bed, a couch, a birthing tub. It does not have the sterile, clinical feel of a hospital. My orders were to walk in laps around the center to get contractions really moving. I did this for at least an hour before telling Anne that it really hurt my bladder and that I needed to lie down. I know she was very worried that labor would stall if I wasn't walking, but she trusted me. Luckily contractions continued. I got through contractions by breathing and focusing, and also by singing. It sounds odd, really, but I would sing show tunes throughout the contractions. It helped me focus on my breath. My favorite was "Man Up" from Book of Mormon.
Time gets a little hazy at this point, but about 4 hours in, Anne checked me, and I was 5cm. I was discouraged. 4 hours and one centimeter? I confided in Anne that I had a real fear that I would sabotage my progress because I was afraid of the pain to come. I think it's only natural to protect yourself from pain instead of urging it on. I told her that though I don't have any proof, I was worried that with Charlotte I didn't push right because I was afraid of how it would feel to push her out. Anne listened and encouraged me that I could do anything and that I would be holding my baby soon. She had me lie down in bed with Jason and we turned the lights out. She wanted me to try to sleep between contractions. She was lying on the couch. I tried to rest, I really did. I was able to drift away a couple times between contractions, but they really started to hurt at this point. I could no longer talk or sing during them. I would push air out in a shushing sound and demanded that Jason apply serious counter-pressure on my lower back. He was pushing so hard that his arms were shaking, but it wasn’t enough for me. I seriously wanted him to beat me in the back. I remember reaching back and pushing his hand even harder into my back. Anne recognized that these contractions were getting us somewhere- she kept encouraging me to stay in the position because it was working. I was getting upset with her, because I wanted to avoid the pain- why would I want to make it hurt worse? Oh yeah- we want labor to progress!
I noticed that my legs were shaking, probably from low blood sugar. I had had very little to eat that day, and had managed to only graze on Golden Grahams and granola bars during labor. Jason had bought me a Publix sub for after labor, but I asked for it then. It's amazing how your body really knows exactly what it needs. I picked the vegetables off without even thinking about it. I needed the turkey and cheese. I ate about half the 6 inch sub, and that really did the trick. I could concentrate more on labor and less on the low blood sugar. I knew I needed the energy for what was coming.
It was about this time that Anne suggested I try my hands and knees. She put a birthing ball on the head of the bed, and had me rest my upper body on it. I will forever remember my face pushed into that birthing ball. I can instantly recall exactly how those contractions felt. It is safe to say that this was the worst pain I had ever felt in my life. Every contraction would rob me of my breath and it seemed my sanity. I wanted it to stop, but I kept going. It’s fair to say that if an epidural had been an option, I would have easily taken it. But that wasn’t an option. Jason and Anne provided lots of counter-pressure, and would also press against my hips, which helped. It didn't make the hurt go away, but I needed it. Each contraction was a stab in the bladder that wrapped back to my lower back. I really wish I could describe the feeling, but I can't. Really- it was the most ridiculous pain. I wanted to arch my back or rock, but the very thought of moving was nauseating. I had been using low moans through contractions up to this point, when my low moans became more a siren, and finally I was just screaming. I appreciate that no one tried to stop me. Screaming was obviously exactly what I needed to do.
Anne checked me then, the second and last time. She reported that I was at 9 centimeters. I instantly asked if I could get in the pool then. Anne said, "Amy, I don't think there's time. It takes 30 minutes to set up the pool." I begged her to do it anyway. She started working on it and Jason stayed with me to provide counter-pressure. It seemed only a short amount of time before I was being helped out of my nightshirt and into the tub. What a relief that water was! It just took a little of the edge off, but I still didn’t want to move. The pain was still intense.
My 45 minutes in the pool were the antithesis of my three hours of pushing with Charlotte. With Charlotte, there was bright light and four people constantly counting and barking at me to push. Here in the pool, there was total silence. The lights were off, and Anne had a small flashlight. The Beatles station was softly playing on our Pandora app on the iPad. No one told me to do anything at all. I was able to close my eyes, lean back on the side and do what my body wanted me to do. At first, I started experimenting with pushing. I wasn't feeling the overwhelming urge to push like I had with Charlotte. Actually, I didn't even know if I was 10cm, but it didn't matter. I was the one in control. I was the one who was able to direct what was happening to me. I tentatively pushed, gauging the situation. During these early pushes, my water broke. What a bizarre sensation- just this pop. Jason says I was so quiet at first that he was really worried that contractions had stopped. I tried gentle, short pushes, but occasionally would really bear down and push hard. When I pushed hard, into my bottom, I could feel something happening. It was painful and scary, and I wanted to avoid it. It made my entire body shake. It very much felt like I had to poop, but whatever it was was hard and painful. I noticed that I was starting to avoid that strong push.
I suppose it was around this time that I sank into myself and had quite a conversation with myself. It went something like this, "Amy, no one else can do this for you. There is no way around this. You will have to push this baby out. You. No one else can do it. Do you want to meet her or not? I know it's scary, and I know it hurts, but you don't have a choice. You have to do exactly what you don't want to and you can't hesitate."
This was all I needed. I pushed my feet against the opposite side of the tub. I pushed with all I had. As she had been doing all along, Anne was checking the baby's heart on the Doppler. She listened, and I am assuming that during pushes she heard the baby's heart rate dropping. She said that I had to push the baby out now. I tried with the next contraction. Jason said that when I would stop pushing, the baby would pop back up. Anne said, "You have to push the baby out now, or I'm making you get out of the tub." It was a good threat! I gathered up everything I had in my body for those last several pushes. I don't know where it came from. I could very much feel Anne's fingers, and I remember thinking how much the whole area hurt. This could have been the "ring of fire" because soon I was hearing "here she comes" from someone, probably Jason. I remember Anne saying, "push your baby out." I don't actually really remember her head coming out. I remember pain, and I remember them telling me to push, and then I felt her entire body slide out. I opened my eyes to see Anne working under the water. Jason told me it was because Violet's cord was wrapped several times around her body, so Anne had to spin her around to get the cord unwrapped. She plopped the baby on my chest. I couldn't stop saying, "Wow!" as I held that wet, squirmy thing.
Anne instructed Jason to get me immediately out of the tub onto the bed. I had suffered from low iron at the end of the pregnancy, and Anne had already told me that she needed to get the placenta out as soon as it detached, so that I didn't bleed behind the placenta and bleed out. This happened fairly soon- about five minutes later. I didn’t see the placenta, and this time I kind of wanted to. How amazing is it that you grow this entire organ that keeps your baby alive and then comes out? Jason did not cut the cord until it stopped pulsing- an important thing, as roughly 1/3 of baby's blood is transferred to the placenta before birth. This way, baby gets everything back before the cord is cut. I was so thrilled to finally be holding that little baby. She was a little on the blue side at first, and needed a little stimulation to really get her crying well. This took a couple of minutes, but she pinked up really fast. I was able to nurse her right away.
We settled in with our girl- all 8 pounds, 10 ounces, 22 inches of her. Anne then told us that was born with a nuchal hand- she had her fist against her face as she came out, something that makes it even harder for momma!
We took our time getting cleaned up, eating (a Big Breakfast from McDonald's) and enjoying the little one. She and I were constantly being checked for anything of concern. Roughly every 20 minutes, they were checking the baby's vitals, my vitals, and were checking my uterus for the slightest sign of hemorrhage. I ended up needing 3 stitches- this was probably the old wound from Charlotte reopened. After almost 6 hours, we were ready to pack up and take her home.
Giving birth naturally was the hardest thing I've ever done, and by far the most rewarding. Even though it hurt like hell, I could move, go to the bathroom, eat, relax, and let my body do what it was made to do. After Charlotte's birth, I was convinced that my body didn't know how to birth a baby. I was convinced that only medicine and medical science could get that baby out. But not only did I go into labor by myself with Violet, I pushed that baby out all by myself without the tiniest painkiller. There is no way to go through that without feeling empowered and that you can do anything at all. I could not be more proud of myself.
Complications did arise, however. When we got home from the birthing center, Violet's respiratory rate was shockingly high. She ended up having to spend two days in the NICU. I will be covering that experience in my next blog. She's perfectly fine now, but..... to be continued.......
