The Cesareans; Long Story Short

To know why Casimir’s birth is so significant to me, I should explain a bit about my first and second births, both cesareans.

Ava was born via cesarean in 2004 due to heart decels during induced labor at 41w4d, 10 days “late”. We were unnecessarily separated for 4 hours after her birth, and we ended up having a lot of trouble breastfeeding.  Years later I would come to understand the induction with cytotec likely played a role in her fetal distress.

Maxine’s birth was a planned hospital VBAC (vaginal birth after cesarean) in 2006 that turned into a repeat cesarean to due malpresentation.  I went into labor naturally this time, but during labor we discovered that she was presenting brow first.  Again, years later I learned that if we’d haven given it some time, her presentation might have changed as labor progressed and it’s possible the cesarean could have been avoided.  I was with the same obsterician as my previous pregnancy though, an OB with a cesarean rate of nearly 50%.  I now understand that your care provider plays one of the biggest roles of all when it comes to the way your labor and delivery plays out.

The Choice to Give Birth at Home

While I was of course grateful to have healthy babies and uncomplicated cesareans and recoveries, I mourned the loss of the natural births I’d hoped to have.  In the years following Maxine’s birth I did a lot of reading and soul searching as a part of my emotional recovery from my surgical births.  I attended two ICAN Conferences and came to learn I wasn’t alone with my lingering feelings of disappointment about my births.  I watched documentaries like The Business of Being Born, Birth as We Know It and Orgasmic Birth and was starting to understand and truly believe that home birth was a safe option for healthy, low risk women.  I was inadvertently getting to know mothers in our homeschooling community who had safely and confidently given birth at home.  Home birth was starting to seem a lot less scary and a lot more normal.  I now believed that if I ever had another baby, my best chance at having the birth I wanted meant finding a care provider who’s philosophy about birth more closely matched mine, and a home birth midwife was going to be my best bet.  Someone once said “It’s not home birth or bust! – it’s stay home for as long as everything is going well.”  So maybe that means you labor at home and stay home through the birth!  Or maybe you transfer to the hospital if it’s evident that medicalized care is required during your pregnancy, labor or delivery.  As a healthy, low risk, educated and informed woman, home birth felt like a safe and reasonable option for me and my baby.

Baby #3

My third pregnancy came as a complete yet welcome surprise in October of 2011.  With the girls now 8 and 5 years old, I figured we were done having children, but I will admit that there had always been a small part of me that knew there would be one more child in our future.  A boy, I thought.  I even remember thinking once that if we ever did have another child, I hoped the pregnancy would come by surprise.  I didn’t want to obsess about conceiving like I did the first two times, I wanted it to happen without even trying.

Well son of a gun.

Shortly after I discovered I was pregnant I got in touch with one of the local home birth midwives who supported women seeking to VBAC at home (HBAC).  Once upon a time I never would have felt comfortable with the idea of a home birth.  It took me 20 weeks to get even slightly comfortable with the idea of attempting a hospital VBAC with my second pregnancy.  I would have completely shocked a former version of myself when I marched straight into the midwives office one afternoon in late October without hesitation to say I wanted to plan a HBA2C.  I remember sitting in her office and thinking I am really here.  After years of personal work, wondering and emotional healing, I was really going to get a fair chance at the birth both me and my baby deserved.

An Active Pregnancy

My pregnancy was healthy and uncomplicated.  I had some queasiness in the first trimester that left me feeling pretty miserable for a number of weeks, but beyond that I felt good throughout most of my pregnancy.  I continued to run until about 14 weeks, and when the cold weather arrived with my second trimester, I moved my workouts to the gym to use the elliptical machine and walk on the treadmill.  At 29 weeks I started seeing a chiropractor help encourage and support alignment in my spine and hips in preparation for the birth.  I did the exercises from Spinning Babies to encourage baby into the best position for an easy birth.  I took prenatal yoga twice a week that I continued until the end of my pregnancy.  I found and read birth affirmations, surrounded myself with positive birth stories instead of scary ones, watched about a million home birth videos on youtube, read Ina May’s Guide to Child Birth, Natural Childbirth the Bradley Way and Birthing From Within.  When the nice weather arrived I started walking outside, 2 miles a few days a week, cutting down to 1 mile as my due date drew closer and my belly grew bigger.  I worked hard to prepare both my body and my mind for this birth.

June 19, 2012 at 40 weeks 1 day pregnant

The Day Before

It feels to me that the birth story of Baby Kaz officially begins on Wednesday, June 27 with an appointment for an ultrasound, amniotic fluid check and Non Stress Test at 41w2d. It was my first and only ultrasound during this pregnancy as I had decided to forgo any unnecessary prenatal tests as a part of my journey toward letting go and truly trusting my body and my baby, two things I wasn’t very good at with my prior pregnancies.

I’d had a string of tough days waiting for labor to begin.  I’d been feeling so discouraged that labor hadn’t started, I was worrying about the baby but also trying to remind myself that we were still within the bounds of normal gestation, especially for me, having gone past 40 weeks with both girls.  I thought I’d worked through so much of these things I was now worrying about, but I also hadn’t expected to go much beyond 40 weeks because Maxine was born at 40w5d.  I had been so sure that labor would begin sooner than later this time.

I reluctantly called to schedule the ultrasound and NST to check on baby’s well being given their penchant for hanging out in utero.  My appointment was first thing that morning, and because I had not had an ultrasound at all during this pregnancy, the technician did a complete anatomy scan of the baby before checking the fluid levels.  Based on the measurements they took, they estimated the baby’s size to be 9 lbs, 10 oz, which was quickly rounded up to “10 pounds!”  They soon started to use words like “gigantic” and “huge” when speaking about baby’s size.  I already knew that ultrasound weight estimates can be off by as much as a pound, so I wasn’t overly concerned about their estimate, I also didn’t feel like I was pregnant with a gigantically huge baby.  (I was reminded though of the way the medical community can unnecessarily scare women who are already in a vulnerable place.)

What was more concerning was the difficulty they had finding any pockets of amniotic fluid.  This could be a sign that the placenta was starting to deteriorate, or perhaps just a sign that I need to be better hydrated.  At 41+ weeks, low fluid wasn’t completely unexpected, and the tech told me to move on to the Non-Stress Test while the OB in the office reviewed my scan and would then come consult with me when my NST was done.

The NST went perfectly and showed us that baby was doing well.  At the end of my appointment, the OB came in to say she was very concerned about the low fluid levels.  She made it perfectly clear that while she doesn’t normally recommend home birth, she felt strongly that home birth was not a safe option for me with low fluid, “a huge baby” and especially my two prior cesarean sections.  She felt it would be safest for me to go to the hospital immediately for induction or repeat cesarean.

My midwife Meg had warned me ahead of time that they might overreact if they discovered low fluid during the ultrasound, so I didn’t panic or rush off to the hospital.  Baby was currently fine, so there was no imminent need to do anything rash.  The OB called Meg to see where she’d like me to go and Meg said for me to go home and so we could speak on the phone and decide together how to proceed from here.

I’ll admit though that I was starting to question and wonder about the best next step.  On my way home I began to prepare myself for possibility of a repeat cesarean, something I had not once allowed myself to consider my entire pregnancy.  I was sad and had a hard time believing I was really in this place again. Frustrated that labor had not begun, I felt like I was running out of time.  I had no idea what Meg was going to say about all this. Would she agree that it was no longer safe to attempt a home birth? I was going on 41 and a half weeks, just like my first pregnancy.  But unlike that pregnancy, I was having plenty of signs that labor was near. I’d been having noticeable contractions on and off for two weeks now.  At my last appointment my cervix was found to be very soft (likely thanks to the Evening Primrose Oil I’d been taking since 39 weeks). For well over a week I kept expecting to wake up in the middle of the night in labor, only to keep waking up feeling completely rested from the best nights of sleep I had in months!

My husband Zak and I called Meg as soon as I got home.  She agreed that this baby should probably be born sooner than later, but she didn’t feel that I needed to go to the hospital for induction or cesarean or that home birth was no longer a safe option. She agreed that the low fluid levels were a valid concern and that we should probably try to get labor started that night.  She took all this new information in stride though, reminding me that all the ultrasound really tells us is that my dates are likely accurate.  She also said her hands told her this baby was not 10 lbs.  She and I both felt that baby was somewhere in the 8 pound range, he or she didn’t feel any bigger to me than Ava (8 lbs) or Maxine (8 lbs, 13 oz).

Speaking with Meg immediately calmed my fears and restored my faith that I could still have the birth at home that I wanted. She was my beacon hope and sanity after feeling the effects of the medical machine I had successfully avoided until now.

Meg told me that the other midwife Sarah would be coming into the city that afternoon and to meet her at their office for an exam to see if my cervix had changed since my appointment the week before.  We talked about stripping my membranes to see if it might help get labor moving. We also discussed taking castor oil that night with the hopes that it might give labor a real kick start too.

I made plans to meet Sarah at noon, so I took the girls to Toys R Us as we’d promised the evening before. We had made an agreement that if they helped purge their room and toy bins of things they no longer played with, I’d take them to the toy store to pick out some small toy. As we walked through the aisles of the store I felt many fears trickle into my mind.

Is inducing labor at home the right thing to do? Is castor oil a safe choice as a VBA2C? Is my baby OK? Am I being irresponsible? What if I leave my children motherless?

I reminded myself of all the reasons I chose homebirth in the first place, a choice I made long ago without a shred of doubt before I even knew we’d be welcoming another child into our family someday.  I reminded myself how completely I trusted Sarah and Meg and knew that they wouldn’t agree to do something they didn’t feel was safe and reasonable. I trusted their experience and knowledge and refused let my mind run away with the all the unknowns. I went back to simply trusting that no matter what happened, we would be able to handle it.

I met Sarah at the office that afternoon and she found my cervix to be very soft and 1 cm dilated. She was able to sweep my membranes and estimated the baby’s head to be at -2 station. She was able to stretch my cervix to 2 cm during the membrane sweep. She palpitated my uterus for a weight guesstimate and she too said there was no way this baby was 10 lbs. All of this news boosted my spirits and restored my faith even further that being at home for the birth was the right choice for us.

After the exam, we discussed taking the castor oil in a vanilla milkshake at about 7pm, knowing it could take 6 to 8 hours to take effect. Castor oil is a stimulant laxative that can get your intestines to irritate your uterus from the inside and often get labor started if your body is ready.  Taking castor oil at 7pm would put me at about 1AM to 3AM with diarrhea. (Oh joy!)  This would give me plenty of time to know if it was going to work or not, in the case that labor didn’t start and I was going to have to make a decision in the morning about going to the hospital for an induction, repeat cesarean or perhaps another fluid check and continuing to wait for labor to begin.

We talked about the possible complications of low amniotic fluid during labor.  I asked if baby could go into distress during labor without a nice cushion of fluid.  Sarah agreed that it was a possibility, but said it was no reason not to try and we would just closely monitor the baby.  She said that if I liked, she could come a bit earlier than she otherwise might to start listening to the baby’s heart rate early on and make sure baby was doing well throughout labor.

It was then that I simply knew that labor would begin that night. I knew my baby’s birthday would be June 28th. I silently apologized to baby that they weren’t going to get to pick their own birthday, but I was doing what I believed to be best given the circumstances of my post date pregnancy and two previous cesareans.

I left Meg and Sarah’s office and ran to the grocery store to find castor oil.  I grabbed a half gallon of vanilla ice cream for my milkshake, as well as a few other groceries to restock the fridge. I felt like I’d been “stocking the fridge” for three weeks straight!  I got home, made some phone calls and took a short nap.  While I was sleeping Zak made arrangements with our friends down the street for an evening play date for the girls so we could get the house cleaned up without pint sized distractions milling about.

My nap was very short, maybe 20 minutes at best, but I’d figured we’d all get to bed early that night and I would have time to feel rested before labor started in earnest.  Zak and I walked the girls the few blocks to their friends house and walked back home again to begin filling the birth tub and tidying up the house.  I’d been having noticeable, random contractions all afternoon and evening, plus a little bit of bloody show, most likely from the membrane sweep earlier in the day. The contractions were mild and irregular, much like they’d been for the last couple of weeks, but they were frequent enough that I still believed labor was imminent, especially with a castor oil milkshake looming in my near future.

It was 8pm when I was finally downing my castor oil cocktail as we walked back to our friend’s house to pick up the girls. I couldn’t taste the castor oil at all with all that cream and sugar, just as Sarah promised.

Bedtime that evening took longer than expected, it was 10:45 before I finally crawled into bed with the hopes of getting at least a few hours of sleep. But as soon as I laid down, I started to feel intense cramping in my lower abdomen, cramps that would not let up no matter what position I was in.  It took only a few moments to realize the castor oil was working already, less than three hours from when I’d taken it. Within the hour I was on the toilet, wondering what on earth I’d just signed myself up for.  Shortly after 12:30 AM on June 28th, I began to notice that these cramps were now coming at regular intervals, about three minutes apart.

Labor Begins

It was 12:45 when I called Zak upstairs to be with me. He’d been getting some work done downstairs assuming I was asleep.  I now needed his company and I also needed his help getting things set up in the bedroom as well as timing contractions so that I was sure I wasn’t imagining things.  We’d downloaded the Contraction Master to his phone a few days earlier, it turned out to be a huge help in timing the early contractions.

I soon needed his help putting pressure on my sacrum to help relieve the contractions I was feeling in my lower back. We live in the city and the houses are very closely spaced. One of my silly concerns about a home birth was vocalizing during labor and worrying that my neighbors would hear me. When the time came though, I decided I didn’t care. This was just how it was going to be. (Come to find out they never heard a thing anyway!) I started moaning in low tones through contractions to help Zak gauge where I was and to help keep my throat open, hoping it would help my cervix open as well.  (Thank you Ina May!)  The contractions were strong and regular, but I was handling them well and felt in control.  I kept reminding myself to stay relaxed and would visualize the contractions as a wave crashing on to the shore, watching it go back out to sea as it would subside.  I focused on staying out of the way of the work my body was doing to bring my baby here.

(If that sounds lovely, please don’t be mislead.  It still sucked.)

Sometimes the contractions would double peak and I kept thinking “WHEN is this one going to be over?!” At one point I was laying on the bed and noticed the book “Birthing the Easy Way” by Sheila Stubbs on the bedside table. Every time I opened my eyes I would read the title on the binding of the book and think “Yeah, right.  The Easy Way.  What a crock.”

Remembering that Sarah had said she’d come early if I wanted her to, I asked Zak to call her at about 1:30AM.  She asked for the details and said she’d like me to continue laboring a bit longer, just to be sure that the contractions weren’t going to peter out and that this was really it. I *knew* it was really labor and these contractions weren’t going to let up until the baby was born, but we agreed and said we’d call back in a half hour or so with an update. I then asked Zak to call our doula Karen (the same doula we’d had with my attempted VBAC with Maxine) because Karen had said she would come as soon as I needed her. I felt like I needed her now and was ready for her to be with us. Zak was doing a wonderful job supporting me, but there were things that I needed and it was too hard for me to give him specific instructions between contractions. It was time for Karen’s support too.

Both Meg and Sarah live about an hour away, and I was thinking about the time it was going to take for them to arrive when I asked Zak to call Sarah back with an update around 2:20 AM. Nothing had really changed, the contractions were coming regularly at about 3 minutes apart, lasting 1 minute, sometimes 2 minutes. This time Sarah said she was on her way and I continued laboring in our bedroom with Zak while the girls slept soundly across the hall.  Karen arrived and soon the two of them were taking turns putting pressure on my sacrum to relieve the pain I was feeling in my lower back with each contraction.

Sarah arrived at about 3:30 and the very first thing she did was listen to the baby with the Doppler. Baby’s heart rate was 120 and sounded perfect. She then asked if I wanted to be checked and I did.  I was found to be 4 cm dilated, 80% effaced, baby at 0 station. She commented that my cervix had made real progress from this afternoon and said “this baby is in your pelvis, Alison!” Neither Ava or Maxine had ever made it that far down, and even though I had no reason to believe this baby wasn’t going to fit through, it was still a huge relief to know we were making real progress and things were headed in the right direction.

I continued laboring and everyone encouraged me, telling me I was handling the contractions beautifully and doing all the right things. When a contraction would hit I leaned against a dresser or wall and would sway back and forth on my feet, bending alternating knees out to the side, much like I’d practiced in the Summer Sanders Prenatal Workout DVD during my pregnancy! It felt like it was working, at the very least it was something to “do” and focus my attention on; it helped me visualize the contractions opening my cervix and my baby working his or her way deeper into my pelvis.

Up until then I had been so hot in the bedroom I couldn’t imagine getting into the birth tub, but around 4:30 I noticed I was feeling cold and was starting to shiver. Getting into the warm water of the birth tub now sounded incredible, I stripped out of my clothes and climbed in, surprised and delighted to find that it provided some very real and instantaneous pain relief. The warm water was soothing and comforting and the contractions I was feeling in my back completely disappeared. I sat on the sinkable cushion that came with the birth tub and found the water to be the perfect depth and temperature. I draped my arms over the side of the tub and reminded myself to just let every inch of my body relax. From my yoga practice, both prenatal and before pregnancy, I knew to look for tension in my jaw and shoulders. I would remind myself to let go and relax those areas of my body. When the pain got really intense I would project myself to the far corner of the room and tell myself “There is no pain in the corner of the room”, picturing the spot where the ceiling meets the wall. “There is no pain over there, I’m going over there to that corner right now.  I’ll come back to my body when this contraction is over.”

Every once in a while Sarah would ask me to stand up in the tub so she could listen to the baby’s heart rate and it was always holding steady between 120 and 130 beats per minute. Everyone was quiet during contractions, occasionally offering me something to drink from a selection of coconut water, ice water and EmergenC. Sarah sat quietly knitting, Karen stayed by my side putting pressure on my forehead during contractions and gently reassuring me in between.  Zak poured cold water over my neck and shoulders, other times he just sat quietly in a small chair near the tub or would run and get things we needed.  The women encouraged me after every contraction, saying things like “that sounded like a good one”, “you’re doing great” and more. I believed them and was so grateful for their kind words.

With the exception of my 20 minute nap the previous afternoon, I hadn’t slept since the night before and was definitely feeling tired. I would sometimes fall asleep between contractions (still 2 to 3 minutes apart) and at one point I woke up saying “I just had a dream that Zak was cleaning the bathtub”.  (That was most definitely a dream.)

It was still dark when I first noticed I was starting to “feel pushy”, but I was concerned that I wasn’t fully dilated yet. I didn’t want to push too early and cause my cervix swell and I voiced this thought out loud. Sarah offered to check me again but I said “not yet”.  She then invited me to give “easy, gentle pushes” with the contractions to see how it felt, so I did. I sometimes found that I pushed harder than I meant to, only because I couldn’t help it, but it felt right so I continued.

It was soon after this that I noticed daylight was beginning to fill the room.  Meg arrived at shortly after the sun was up, and when Zak’s alarm went off on his phone I knew that it was now 6AM.  Around this time my girlfriend Sharon arrived too, the one friend I’d invited to the birth to come and be my birth photographer and to help see to the needs of the girls.  When I was invited again to get out of the tub to check my progress, I agreed. Changing positions always seemed to trigger a contraction so I wasn’t very eager to move, but I eventually did. Sarah soon told me that I was 10 cm and baby was at +1 station, but I had an anterior cervical lip that needed to move before I could really start pushing. Sarah offered to try and hold the lip back while I pushed gently through the next few contractions, but this sounded far from pleasant, so I chose what was behind Door #2; have a few more contractions without anyone holding anything anywhere and wait and see if the next few contractions might get that lip out the way.

While I was on my back they listened to the baby’s heart rate again, and for the first time during my entire labor the baby’s heart rate was down to about 90 bpm. They said it was normal during this point in labor so long as it came back up. They asked me to roll over on to my side and I did, and still, baby’s heart rate did not recover like they would have liked. I was then asked to stand up, and finally baby’s heart rate went back up to a happy 120 bpm. We decided baby just liked it better when I was standing and so I went on laboring in an upright position.

After some time I was checked again to see if the cervical lip had moved. It hadn’t, so I finally agreed to let Sarah try and hold the remaining lip of my cervix back while I pushed through a couple of contractions. They listened with the Doppler after a number of contractions and found that the baby’s heart rate was down into the 70’s. I stood up and the baby’s heart rate came back up.

More contractions, more seemingly involuntary pushing on my part, I was starting to lose the calm I’d been holding onto for so long. Half pushing was really intense, it was a scary feeling.  I couldn’t really push until my cervix was completely out of the way, and I couldn’t lay down to have Sarah help manually move the cervical lip without risking that the baby’s heart rate might drop, so Meg soon suggested that I walk up and down the stairs, saying the change of movement in my pelvis might help re-position the baby and move the cervical lip out of the way.

The idea of navigating the stairs sounded as appealing as another castor oil milkshake, but I agreed and eventually made it downstairs with Zak and Karen by my side. Another contraction hit when I got to the bottom of the stairs and I hung from Zak’s shoulders as I pushed loudly and uncontrollably. When I came back upstairs they said “that sounded like a good one!” I thought it had sounded awful, but whatever.

Laying down once again to see what was going on with my cervix, Meg checked me and said she could no longer feel the lip, just a bulging amniotic sac and the baby’s head was now at +3 station. And once again, when they checked baby’s heart rate when I was laying on my back, it was back into the 70’s again. They helped me stand up, and I naturally assumed it would rebound as it had each time before, but this time, it didn’t speed up. We kept listening to it on the Doppler, waiting, waiting, waiting… but it held steady at 70 bpm.

Despite this, it still caught me off guard when Meg said “We’ve got to go.”

Go? Go where? To the hospital? I even said “REALLY?” out loud.  I was so far away in Labor Land I didn’t see that coming.  This wasn’t at all what I had expected, I never even packed a hospital bag “just in case”.

Meg said yes, it was time to go, something wasn’t right.  Suddenly everyone flew into action. Sharon ran to grab my bathrobe. People started gathering things and making toward the stairs. I made eye contact with Zak and was caught off guard to find a panicked look on his face. It was hard to see my normally calm, cool and collected husband even slightly flustered. I remember Meg saying that I was just going to go to the hospital and continue to do what I’d been doing here at home. Sarah added that we just wanted to be somewhere with better infant resuscitation if we needed it. It scares me now to write that, but at the time I was too overcome with pain and the intensity of pushing to be scared.

We got downstairs to the door and realized my shoes were not there with everyone else’s.  Sharon said to wear her flip flops and she kicked them over to me to put on.  The next thing I knew we were outside, looking at the driveway full of cars trying to figure whose car we should take to the hospital. Our car was completely blocked in, as were the two other cars that we might have been able to take. Suddenly I found myself squatting down in the driveway and pushing hard with a contraction, holding myself upright against the nearest car. I thought “please, please, PLEASE just let the baby’s head come out RIGHT NOW, right here in the driveway!”, but no head appeared.

It was quickly decided to take Sharon’s car because she was parked on the street. We hurried down the driveway and I made it across the street before another contraction hit and I found myself once again involuntarily squatting and pushing. Here too I hoped that the baby’s head might make its debut, right here in my neighbor’s front yard, but still nothing.

There was a lot of hustling around, people moving quickly to get the doors unlocked, removing car seats, Zak running back into the house to get his wallet, someone laying down a chux pad to protect the front seat where I was about to sit. When I sat down I felt something bulging under me and I yelled out, afraid I was sitting on the head. Sarah took a quick look and assured me that the head was just low and to go ahead and sit down.

Finally we were on our way, Zak and Sarah in the backseat, Karen driving, Sharon staying behind to watch the girls (who had slept through the entire thing and were still sleeping when we left) and Meg who also stayed behind to call the hospital and let them know we were on our way.

It was a cool, quiet morning and there was very little traffic. The time on the clock in the car said 7:39. Between contractions and pushes I directed Karen to the hospital that was only a couple miles away. I continued to have contractions and push in the car, announcing “I can’t help it!” with each uncontrollable push. I’d never officially been given “permission” to really start pushing, so in my mind I thought I wasn’t supposed to be pushing yet.

Sarah leaned over the seat a few times to listen to the baby’s heart rate and each time it was reassuringly above 100 bpm. I soon noticed I was extremely thirsty, my throat felt SO DRY from the noises I was making during pushing, but we didn’t bring anything to drink. I looked down to notice a streak of blood on my inner thigh and realized what I sight I must have been. Completely naked under a robe that wasn’t even tied closed, wearing my glasses and my girlfriend’s flip flops, hair pulled back into a mangled pony tail. I said outloud that I just wanted the cesarean.  I wanted this all to be over with. I didn’t care anymore, just make the pain stop, just get this baby out. The thought of sitting through any red tape at the hospital seemed unbearable, I had no idea what would happen when we got there and I just wanted it all to be over with.

We pulled up to the ER entrance at 7:43 AM (Karen told me later), just 4 minutes from leaving the house. We got out of the car and the security person at the door asked what was going on. Apparently it wasn’t obvious! Sarah said “she’s about to have a baby!” and he helped me into a wheelchair and told us to go straight through the ER to Labor and Delivery.  Zak pushed me through the ER doors with Sarah close behind and we ran through the ER waiting area.  The security guard instructed us to go straight to Labor and Delivery and Zak was soon running me through the halls of the hospital, looking for the right elevators that would to take us up to L&D.

As we flew down the hospital hallways, I said again that I NEEDED something to drink NOW, and Sarah said she’d get me something as soon as she could. I continued to have contractions and continued to push this whole time. Whoever described pushing as reverse throwing up was exactly right: I-don’t-want-to-do-this-but-my-body-is-MAKING-ME-uuughhhhh!!!

Despite all the involuntary pushes, I don’t think I truly believed at this point that this baby was going to come out of me. All this pressure I was feeling in my pelvis just felt too impossibly huge to budge.  I was pushing because my body was making me, pushing until someone would make the pain stop and cut me open once again.  I didn’t care anymore.  Just.  Make.  It.  Stop.

When we finally made it to L&D, the double doors swung open to reveal a wall of medical staff suddenly standing before us. Much to my surprise, the first person I made eye contact with was the OB from the ultrasound the morning before, the doctor who quite clearly told me NOT to have a homebirth. I watched her raise her eyebrows as she said “well, hi there!” with a smile. It felt like she was saying “I told you so!” I would have liked to roll my eyes at her or maybe even stick out my tongue, but instead I just sat there in a helpless daze of contractions and involuntary pushes.

But before I could stick out my tongue, we were gone in a flash and were being ushered into a delivery room. They got me out of my house robe and into a hospital gown. I was moved to the hospital bed and wrapped with those familiar blue and pink elastic belts as they hooked up me up to the monitors. I begged for water and a nurse said I could have ice chips. Oh how different things suddenly were here!  At home I barely had to nod and a cup with a straw and array of beverages would be brought to lips. Now I was begrudgingly offered some sad little ice chips in case I was going into surgery soon.

A friendly-enough OB came into the room and started talking about what our options were. He said “we hear this is a pretty big baby” (presumably from my ultrasound records from the day before) and then rambled on about being concerned they wouldn’t be able to pull the baby out with the vacuum.  He said he was leaning toward a cesarean as our best option, and I remember thinking “if they can’t pull this baby out, how on earth am I going to PUSH this baby out?!” Even though I’d said it in the car, I didn’t truly want a cesarean, but I wondered why they weren’t rushing me off to the operating room now that we were here. Did I still have a chance of delivering vaginally? He continued to talk while I grunted and pushed through more contractions. It seemed obvious to me that I wasn’t listening to what he was saying, but he just kept talking though all the noise I was making. Eventually I heard him say “maybe I’ll wait until you’re done…” and finally stopped talking.

Through contractions I begged for someone to make it stop, someone just please do SOMETHING.  Why am I the only one doing anything?  ISN’T IT SOMEONE ELSE’S TURN TO PUSH NOW!?  Sarah and Zak kept encouraging me and cheering me on, telling me that I was doing it.  Sarah leaned in and said that if something was seriously wrong they would have whisked me off to surgery already.  She kept encouraging me to just keep going, that I didn’t need a cesarean, that I could do it.  At some point the baby’s heart rate dropped again and they had me roll to my left side. A nurse put an oxygen mask on my face, and throughout it all I kept contracting and kept pushing and kept saying “I can’t help it!” with each push. I felt Zak grab my chin and told me to open my eyes and look at him. He had tears in his eyes and said to keep going; he wouldn’t stop saying I was doing great and I was almost there.

When Karen was back in the room after parking the car, I had the three of them at my side once again.  They simply refused to let me give up and were relentless with urging me to go on.  Keep going, you’re doing it, you’re doing great – like a broken record.  I remember thinking that they didn’t know what they were talking about, there was no way I was going to get this bowling ball through my pelvis. Soon a resident OB was sitting at my side, talking to me about the risks of repeat cesarean and holding the consent form on a clip board in her hand. She was pointing to items line by line with her pen, all the while I was pushing, pushing, pushing, barely opening my eyes to look at her or the form.

She then said the words that I heard crystal clear, “…now if you could just sign the consent form…” and at that moment, I knew I wouldn’t sign it. I couldn’t sign it. If I needed an emergency cesarean, they were going to have to wheel me into the OR with an unsigned consent form. There was no way I was putting my signature on that piece of paper.

In the next moment, I finally felt the baby’s head beginning to stretch my perineum. I was still laying on my side and managed to get out “can you see the head!?” Zak lifted up the sheet that was covering my lower half and gasped “Yes! Yes! I can see the head!” He was crying and so emotional, hearing his strong reaction renewed my strength. Now I finally knew that I was going push this baby out. My thoughts of “how can I push this baby out if you can’t pull it out” had now become to “F you and your vacuum, WATCH me push this baby out!”

I noticed the energy in the room suddenly shifted and it seemed like there were people suddenly moving quickly and in every direction, as if what was happening was unexpected.  I was still on my left side, and Karen told me to lift my top leg and pull it into my chest. I shook my head, there was no way I could do that.  She then moved Zak to the bottom of the bed and put my foot on his shoulder to use as leverage and told me to push against him. One push like that and I knew it was working, that push felt different. Karen moved him closer to me for my next push, making a significant difference in the strength and quality of that push too. I felt the baby’s head moving down, really stretching my skin now. I thought about all the births I’d watched on youtube and reminded myself that the baby’s head was probably going to slide back in before it was out for good, and then thought “I did SO many kegels this pregnancy, that head is NOT going back in, dammit!”

I asked/panted if his head was out and someone said “almost!” I continued to push with everything I had, still pushing against Zak with my top leg and remembering that Sarah had told me to “hold my sound in” as I was pushing. I waited to feel “the ring of fire”, and while I felt some burning, that part wasn’t quite as intense as I had expected. I kept thinking that I was probably pushing too hard and too fast. I felt myself tear as the biggest part of the head emerged but I didn’t care, I just wanted this baby out NOW.

When the head was finally out, my next thought was “I hope the shoulders don’t get stuck…” but before I could finish the thought I felt my baby’s entire body slip out of me. I opened my eyes after what felt like an eternity of keeping them closed and looked down to see a very pink baby who was already starting to cry. I then looked to see if it was a boy or a girl and got a clear view of his little boy parts.

Although I had no personal preference for a son or another daughter, Zak wanted a boy and I very much wanted that for him. I didn’t admit it to many people, but I had strong inclination all along that this baby was a boy. I knew he was a boy before I even knew we’d have another child some day.  I was so happy and thrilled to say “It’s a boy!” when I laid eyes on him. Zak later said that at that moment, he wouldn’t have cared if the baby was an alien, he was just so happy he “came out the right hole”.

They immediately put my hot, slippery baby boy onto my chest and the only feeling I had at that moment was disbelief. It was over.  My baby was here! He was a boy! He was perfect! I did it! I pushed him out! I did it and we all survived!

I watched a pair of hands move to clamp the cord, and I reached down to block them and practically yelled “not yet!” They stopped, but waited only another moment before clamping it and then offering Zak a pair of scissors to cut the cord. The hustle and bustle in the room began to slow down, and everyone was congratulating us and the room felt alive with positive energy. So many of the hospital staff members were smiling and said they were so happy it turned out this way for us.

His 1 and 5 minute apgars were 9 and 9, he peed and pooped on me very soon after he was laid on my chest (which I came to learn later was a sign that he was in fact in distress…) Meg arrived shortly after the birth and she and Sarah stayed with us while my partial third degree tear was stitched up and I attempted to get him to nurse. Meg and Sarah looked at the tracing from the monitors and weren’t able to tell what the cause of the heart decels were, but later said it was probably due to cord compression from the low fluid.  It wasn’t until then that they told me they had decided to transfer to the hospital because they suspected uterine rupture, one of the biggest fears of any VBACing mother.  I told Meg I was so glad she didn’t tell me that at the time, and she agreed that there was no reason to worry me at that moment.

They said that the heart decels were the leading sign of uterine rupture, and the fact that my contractions during pushing were starting to spread out was another. (Something I didn’t notice or remember.) She said the one reassuring sign that it wasn’t UR was that I wasn’t showing any signs of going into shock, I wasn’t bleeding profusely and my vitals were stable.  None of it mattered to me now.  He was here and I was glad they made the choice to come and play it safe. I was so grateful to have my supportive birth team at my side the whole time, the people who knew what I really wanted, despite anything I was saying to the contrary in the throes of labor.

After an hour or so he was weighed and measured, 8 lbs 14 oz (not 10 lbs or even 9 lbs 10 oz!) and was 22 ½ inches long with a 14 1/2 cm head.  My biggest baby yet!  Born at 8:07 AM, less than a half hour after pulling up at the emergency room entrance.

The Afterglow

The difference between recovering from a natural birth compared to a cesarean is astounding.  To be able to get up and out of bed within the hour of his birth was amazing.  My tear felt like a paper cut in comparison to a cesarean incision.  To have my fresh baby put directly into my arms instead of having him whisked off to a nursery with my arms strapped to a table, it was every bit as wonderful as I dreamed it would be.

My experience only proves to me further that home birth is safe.  Homebirth midwives don’t take chances, if something isn’t going right they transfer to the hospital when more assistance is needed.  Even though we didn’t end up needing hospital assistance, I still believe the transfer to the hospital was the right thing to do and probably helped too.  It gave me a huge rush of adrenaline and the physical movement it took getting from the bedroom to the car to the hospital likely helped the baby descend more quickly.  All of these things likely assisted in his quick delivery and saved him from needing any resuscitation after birth.  He WAS in distress, I learned later that his heart rate dropped down into the 60’s at the very end and if it would have taken much longer to push him out they probably would have taken me in for an emergency cesarean.  I am very grateful that the hospital was there when we thought we might need them and I’m most grateful of all to my wonderful birth team that never stopped believing in me.