Friday, August 8, 2008

Simone's Birth Story

This is written to her, so there's more detail than the average "consumer" needs. ;) I want my children to know the story of their entrance into the world, so they get the whole scoop.  Everyone else can feel free to skim or skip. =)

To my amazing little girl, on her first day of life:

You have arrived. I doubt you can imagine the power of that statement for me, as we struggled so hard and so long for you to be born and I sit here only 18 hours from the moment you emerged from inside of me. I don’t wish away a moment of that now that you are here, because I see that it was part of who you are – and the story of you and of us. We did it, sweet girl. I can’t believe I get to hold you and smell your sweet baby head. I’m so glad you are safe. You are beautiful. You are here and you are so, so loved.

Your birth was one of the most complex experiences of my life – on an emotional, physical, spiritual and mental level. It shaped me in a way that only birth can shape a woman. Your birth just became another incredible variable in my story of my life, and I love everything it taught me.

Things started out pretty normally: I started having regular contractions on Tuesday at night. They were consistent and getting strong and they were the “real” ones that radiate from back to front. I felt this electricity that you were on your way. From 11pm until morning, I felt this excitement about each new contraction. In the morning, I called the midwives and told them that there had been a regular pattern for about 8 hours but they weren’t worth coming over for yet…as I could handle them easily.

A friend came and picked up the boys, and Dad helped ready the house for you. Around 11am, they started drifting farther apart in frequency. We walked down to Tropical Smoothie by the boardwalk trying to start things up again and anything else we could think of. Nothing. There started being stretches of an hour or so with no contractions, so I kept in contact with Jenny and Terri (the midwives) by phone. They said it wasn’t unusual for a mom to stop having contractions during the day, as babies usually like to be born at night.

Jenny suggested we go out to dinner and just enjoy our day together. We decided to see “The Dark Knight” (Batman) at the theater, thinking the darkness might trick my body into thinking it was night. I had quite a few contractions then, but decided to relinquish the hope that this was the real thing, and I really wanted to bring Jack and Andrew back home. That was the longest Andrew had ever been away from me, and it felt strange. Jack didn’t want to come home and leave Ethan, as they wanted to have a sleepover. They’d been to the Botanical Gardens and Jumping Monkey and had an active day, so they both crashed asleep on the way home.

When we got the boys, my contractions started up again. Strong, frequent contractions, although they bounced around a lot in terms of spacing. Most of the night, they kept me up with the intensity. I couldn’t sleep through them. I was sure the day earlier had just been a fluke and you would be here soon.

My water broke about 1:15am on Thursday the 7th. With Jack and Andrew, my water didn’t break until late in the labor (Andrew came out just 15 minutes after it broke) – so I was a bit stunned and confused by what had just happened. I’d been in the bathroom and started walking back to the bed. I felt an odd “pop” in my cervix, and then laid down – and water spilled out like I’d just wet the bed. I think I was expecting more, because I’d heard moms use terms like “waterfall” and saying, “Oh, you’ll definitely know.” Well, I called Jenny saying: “I know this is my third baby, but did I just wet my pants or was that my water breaking?” She was sure from the description that it was my waters, especially after I had a contraction over the phone and more water gushed out. “Well, you’re definitely starting labor then!” she said. “Congratulations! I’ll try to get a bit of sleep until you call back saying you need us, but I suspect things will start picking up and you’ll call back in 20 minutes.”

I had a few really strong contractions, and I was sure that this was going to keep them going. After a particularly intense one, I thought: “I really need to sleep. I might have a big day ahead of me.” To my alarm, I woke up two hours later having had not one. My instincts were starting to feel strange.

That morning, Jenny and Terri came over to “labor-sit.” I didn’t really need their help with the contractions, as I found they were fragile – I had them regularly if I was in my “birthing cave” and by myself. But having anyone around or even Dad made them taper off. We knew I had to have you in a certain amount of time now that my waters broke, so we were getting serious about trying to induce a more regular pattern. They even gave me these herbs at 10-minute intervals that start off most women. Nothing was happening. I couldn’t push aside the voice in my head saying, “This isn’t right. This isn’t right.” We were nowhere close to “danger” at that point and your heart tones were really strong, so my feeling made no logical sense.

They sent Dad and me into the shower for some alone time, saying the oxytocin of snuggling and being with Dad would help things along. I sat on the birthing ball in the shower telling Dad: “I think I need to go to the hospital. Simone really needs to come out. My body is shutting down and we’re running out of time.” I know it sounded strange outside of me, as we’d had no indication there were issues.

I felt a lot of things with Jack and Andrew’s labors, as they were both a bit complicated, long, and took some interventions – natural ones, like lots of re-positioning to get their heads back in place. But never even once did I feel a sense of doom. I felt a sense like I couldn’t do it or they were stuck when I hit the Dark Place right before they were born. But there was never even a moment where I felt like I was truly scared about my baby. I felt that way for the first time ever with you. And even odder, Jenny and Terri were two of the most experienced, knowledgeable, caring, and perfect midwives I could have chosen for your birth. There was nothing in them that set off alarms. I was blown away by how they handled birth and how much they knew. So what was I sensing?

When they checked me, I was about 4 cm dilated…which didn’t sound like much for how long I’d labored. They could feel, though, that your head was asynclitic. And they were the first ones who’d ever told me that my cervix wasn’t centered but off to the side– which cleared up things about my previous births and why I had so much prodromal labor and long deliveries. But your head in the wrong position made the “doom” feeling even stronger – as I’d had two babies with malpositioned heads. I knew what that felt like. The labors had more contractions and more painful ones…. they didn’t stall out.

They’d been keeping a close watch on your heart tones and my blood pressure/pulse and making sure all the vitals were strong, but I will never forget how seriously they took me when I came down from the shower, sat down near them and said: “I think I need to go in to the hospital.” For whatever reason, not one labor stimulation option available at home was working, and I needed to know more about Pitocin. Was it going to force your labor along, even if there was some hidden variable keeping you stuck - like a wrapped cord or something? They said the hospital would do the same things they were doing, but with machinery – watching your heart rate, etc. If there was something keeping you up inside me, we’d know at home or at the hospital – but at the hospital, we could use something like Pitocin that would crank up my contractions.

Since my waters were broken, the hospital had an 18-hour policy until you’d need to be delivered. If we went in early, they wouldn’t have to over-correct and panic. We’d leave ourselves time for options. And both Jenny and Terri really honored my maternal instinct and never questioned it, even though you hadn’t been showing any signs of issues. That meant more to me than they likely realize.

It was the most non-urgent hospital transfer ever. We packed up some things, got in our separate cars, Dad and I got really lost…and finally, we made it there around 5:30. We went to a hospital farther away that is really accommodating about homebirth transfers, so it was in Norfolk instead of the one right by. They had an equal sense of calm about us, as they knew about my water breaking and my stalled labor and that I was there for Pitocin…but I just hung out for awhile, filling out forms, answering the same questions a few times for different people.

The midwives transferred care to the hospital, so I was under them now – and not the midwives. Terri stayed as my doula and Jenny ran to catch her plane. She’d stayed until the very last minute she could with my labor until the other midwife was on call, really believing that she might be able to see your birth. I was disappointed for her that she’d put in several days of devoted attention to me – even over the phone – and then would miss your actual birth. But I also know her presence in that period was so important to me and did so much for the lessons of your birth. I really needed her there.

Terri has been working in hospitals for decades as a doula, even alongside being a midwife assistant and helping with homebirths. So I knew she was going to be my perfect labor support along with Dad. I had a lot of concerns about what was going to happen with you now that we were in the hospital. I’d start crying about certain things and feeling really emotional… like were they going to separate you from me right after you were born? The way that hospitals treat babies like objects after birth (sucking them out under bright lights and whisking away from mama) was something that had bothered me about Jack’s after-care, and had been a big part of wanting to birth you at home. Andrew had been handled so gently after birth. Terri assured me you’d be able to nurse right away, snuggle with me, and then having only limited (if any) separation from me…assuming things went well with your birth.

Despite my overwhelming need to get you out, that fear that something wasn’t going to go right with your birth, getting a C-section concerned me. I was trying to make peace with what that might mean – the respiratory things, the separation, and the drugs that made it harder to nurse. I didn’t feel good about giving you Pitocin, but I knew that’s what we needed for you to be born. I was hoping that a lesser-of-two-evils might prevent you needing to be a C-section. But that voice telling me “She needs to be born!” was getting stronger.

We got there at 6:00 but the Pit didn’t start up until about 9. So I was sitting in this hospital gown with Terri and Dad next to me, my contractions picking up a bit, wondering if I’d made the right choice. I had these tubes stuck all over – the IV with antibiotics because my water had broken, the pulse thing, the fetal monitors. When I needed to go the bathroom, we had to unhook about 5 cords and wheel the IV thing. Such a different experience from home, where I could go from the pool to the bed to the toilet to the birthing ball and make sure I was comfortable. Until I got the Pit and started feeling like we were doing something we couldn’t have done at home, I was feeling frustrated that I’d made the wrong decision. I knew I couldn’t labor as well there, and feared they’d not induce things and I’d be left with a less effective labor.

By that point, you’d shifted positions from asynclitic (like Andrew) to posterior (like Jack). The contraction that started it made me think I’d just pulled a muscle in my back. The change was remarkable! When Jack was posterior, I had nothing to compare it to. Now I could see how it was freezing my body up. When they turned on the Pitocin, my back was getting ready to explode with every contraction. Dad squeezed my pelvis and put counterpressure on my back with every contraction. Terri massaged my back. But beyond the physicality of that stage of the labor, there was something even more difficult for me – the mental and emotional place I was at, thinking that something was very, very wrong with your birth.

We called the nurses in and I tried to explain to them that I didn’t feel like something was right. They told me your heart rate was good and that there was nothing wrong with you. I knew you were okay then…what I was feeling was that we needed to get you out soon. And there was no way to explain it beyond just being so sure that the instinct in me couldn’t be wrong. They thought it was just the pain of the birth and tried to explain that posterior babies were “intense” contractions…but I’d been through that before. I was feeling like I needed to go to the place I’d been so scared to go…. that if you didn’t come out soon, we needed to take you out with a C-section.

I think both nurses thought it was just about pain, so they suggested I get an epidural. I’d never had one before and didn’t want one…and it didn’t seem like it was going to move me towards feeling safer about you. They sent in the anesthesiologist to talk to me about it, and I was so unimpressed by her. She seemed annoyed at my need to focus on the contractions….as though I was wasting her time. Since I didn’t want the drug anyway, I felt like I WAS wasting her time. When I learned that I’d be under general anesthesia with a C-section if I hadn’t had an epidural, I called them back in and said I wanted to get one. I was determined to not be knocked out for you and to be able to hold you, and this seemed like the path that would get me there.

Dad was really concerned about me. Because of the intensity of that stage of labor, I imagine it looked to everyone that I was making a decision that didn’t fit with me. Dad said later he was afraid I would just be devastated – not by any pride of the epidural, but the effects of it on you. Because of that voice in me, though, I knew I needed to put away idealism and focus on what was going to birth you soonest. I was at a place of mental clarity and knew I needed to see you shortly and get you safe. I’d always thought that medical interventions were amazing, but only if used in the right circumstances. Used unnecessarily, they created more issues than they solved – especially birth. It was pretty clear to me that your birth was going to require things that my previous births hadn’t needed.

They came in and gave me the epidural at 11:00 pm (you were born at 11:56pm). I was only at 8 cm dilated at that point…the same amount of dilation when I came into the hospital with Jack’s birth and said to the midwife: “If I’m still at 2 cm, please lie to me. It’s been a really long day.” So even though the nurses felt like I was progressing well, I think I was a bit haunted by knowing that it’s the pushing stage where things get rough for my babies. Jack wasn’t born until 16 hours after I was at 8 cm. So when they assured me things looked great, I knew we weren’t in the clear. Perhaps because of my goofy cervix or just the weirdly placed heads, my babies don’t just push right out historically.

The epidural was nothing like I expected – but it ended up being in a good way. I thought the epidural would numb any feeling I had, but it didn’t even make a dent in my contractions. Perhaps because they gave me a low-dose since I was near pushing or because my contractions had been so much about pressure in the first place, there was no relief in the pressure in my back or my uterus. I also later learned the scoliosis can make it not work.

Before they gave it to me, Terri specifically asked, “Will this help with the back labor?” “Oh, absolutely.” Then when I told them I could still feel everything, the next doctor said: “Epidurals don’t do anything for back labor, as they’re only below the waist.” Hmm. I was so grateful on an emotional level that I’d gotten it for the potential C-section and not the pain relief, as my body was still able to relax just having made the decision. Knowing how little it affected my pain level, I think that’s perhaps the most important changed variable. I don’t really know, as so many things about your birth were a head-scratcher.

The pain between contractions did go away, even though the contractions were just as intense, and I went into the same floaty, incredible space that I’d been in the boys’ births. I was talking nonsense to Dad and Terri, and then thinking to myself, “That made no sense, but I don’t care.” Terri commented that most of her clients get more lucid and pulled out of that space if they have an epidural, which I thought was interesting. I think I knew I’d taken a step towards getting you out safely (and avoiding G.A. if it came to having a C-section) and my mind could rest. Moving the thoughts out of my mind about the unknown variables meant that I could just experience your birth.

I moaned my way through the contractions just like earlier, and was floored by the change in pressure in my uterus. I could feel a few key things: The nauseatingly intense pressure while you rotated inside my uterus, and a very, very sharp pain in the lower right hand side of my uterus. I could also feel your feet pushing up against my ribcage, attempting to move down.

Later, I learned that the incredibly sharp pain in my lower part of my uterus might have been your shoulder dystocia, because they commented after your birth that you’d had it…and something in me realized that my feeling of doom might have been about that. While hands and knees contractions could have helped, and I know Jenny and Terri were more than well equipped to handle it, it was one more variable in your birth that wasn’t adding up to a “straightforward birth.” With none of the other present variables (rupture of membranes, stalling labor, seeing meconium, asynclitic head, then posterior head, and then shoulder dystocia), any one of those could have been overcome. But the combination of all of them made your birth a very intriguing ride for all of us.

And despite the epidural being for the C-section possibility looming, the fact that you were born within an hour of the epidural tells me that was a necessary component for you. While it didn’t take away the pain I’D been having, it must have relaxed things in a way that allowed you to be born more easily without trauma, even with your shoulder dystocia.

I was also elated that it didn’t really take away my feeling, as I could push easily and feel you move down. Being able to stay present emotionally in the birth was one reason I’d never wanted the pain relief. I can handle pain more easily when I’m absorbed in it and it’s moving toward something, like you being born. I wanted to feel you at every given point.

They came in to check me after about a half an hour of the epidural. They saw I was “complete,” and everyone jumped into action. I was in serious denial (and Dad was too!), so it seemed a bit silly to have all these people suddenly filling the room to look down my birthing canal. With Andrew born at home, it was a dramatic moment – but in such a different way. I told Dad and Terri they reminded me of Oompa Loompas – it’s a teaching hospital, so there were so many people in there, wearing matching scrubs.

They had me start pushing, but I couldn’t really imagine you were going to be born this way – that I could have you vaginally. I pushed “just because” and didn’t really emotionally commit to it, and then they said something about seeing hair. Dad looked down with a disbelief that you were so close to being born and exclaimed with a pure joy: “She has dark hair!” and I was so moved to tears that he’d just seen his baby girl. I pushed so hard for him, so he could see more and more of you. I was so motivated by hearing how excited he was getting. I couldn’t believe that this was working. They all seemed to believe that you were going to be born, even taking off the bottom half of the table to “catch” you.

Within a few pushes, your head was out. A few more and some work on the shoulder dystocia and you were out. You were beautiful! Fantastic Apgars, so healthy and alive! They gave you to me after they suctioned out the meconium, and you immediately started to nurse! I was so glad you seemed completely unaffected by the drugs. Terri said it’s likely because you had it for such a short period. You had a great latch and a strong nursing instinct from the first moment.

Snuggling with you and seeing that you were finally here was the most incredible high. Terri looked over at me and said: “Well, it looks like you like her,” and I realized I’d had this gigantic, dopey smile on my face. My little girl.

Since my birth with Jack, I’ve been so convinced that each birth is given to a woman to teach her something that will change her irrevocably. It becomes part of our female tapestry and this integral part of who we become. Your birth, sweet Simone, was a lesson in surrendering. To listening to myself, to believing in the inner voices even if they don’t make logical sense, and to shifting gears and knowing that the end result might be nothing like you imagined…and yet still absolutely perfect. I didn’t need my non-dramatic homebirth for your beginning of life to be absolutely perfect. And while I hated the IV, the cords, the nurses that chatted through my contractions, and other things about the environment for birthing you, that was where we were put for your birth.

And to think that the things I was most sure about going in…like a resolution against an epidural or a C-section only if absolutely life endangering, were the things your labor needed most – even if not the actual procedure, my openness to whatever it took for your birth.

I’ve always told Dad that homebirth isn’t for everyone, but that it was a really amazing way to have a straightforward birth. Without all those variables stacked against your birth, I absolutely loved laboring in my bed, eating my rice dish and chatting with the midwives, and knowing that I was in amazing hands. I never once doubted their expertise. Dad and I had a good laugh about the doctor doing the ultrasound in the beginning (when I arrived at the hospital) to assess size and position of the baby. Jenny and Terri did that with their hands and were more accurate. They could just know where the baby was by feeling. The ultrasound told us 6 lbs 14 oz, and you were born at 8 lbs 10.4 oz. Jenny D felt you through my skin a few weeks ago and said: “I think you’re going to have another babe around 8 lbs.” The docs also had no idea why I wanted them to delay cutting the cord, which shocked me. I can see disagreeing, but not even being aware of the physiology?

And the best part about it all? That there are noooo regrets – even though we changed our vision and plans for how you were “supposed” to be born. The sequence of events ended with a perfect, precious, healthy little girl.

After you were born, they brought us to another room to sleep. I was so excited beforehand to be able to sleep, since I’d slept only a couple of hours over the last 3 days. But I was so mesmerized by you…the miracle of you…that I just sat awake watching you breathe and sleep and feeling in awe of your perfect tiny little fingernails.

Dad has been doing everything today, because I’m having a hard time walking well and I need to rest up. We discharged this morning from the hospital, since we didn’t really need the aftercare stuff – you were going to be a homebirth, so we had your pediatrician in place for an office visit. We came home and I crawled into bed with you, and we’ve been snuggling and nursing all day. While you sleep next to me (you look so beautiful!), I’ve got the laptop and am writing this letter to your future self.

I feel so much triumph and amazement about your birth. How much you overcame so many obstacles to being born and yet still came out absolutely, wonderfully perfect. I am in absolute awe of you, my sweet little girl. I am so happy you’re here. The boys came into the room to see you and fell instantly, madly in love with you. Your place in this family is so cherished.

I can’t help but wonder if the adventurousness of your birth points to your path in life…twists and turns that might defy expectations, but always ending up exactly where you’re supposed to be.

You are very, very loved. Welcome to the world. I’m so honored to be your mom.

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