Monday, November 10, 2014

Marian's Birth Story or The Homebirth

Right around the midpoint of the pregnancy I participated in this thread at bearing's that meandered to the subject of homebirth. I had developed an interest in homebirth over the years, but didn't think it would be possible for me due to the nature of my labors and never pursued it. After bearing suggested that someone with my labor history needed to be prepared for a homebirth just in case, she hosted this post about all the secrets of homebirth and my interest was especially piqued. Soon after this discussion, a lady in my town delivered twins on the side of the interstate as she was trying to make it to the hospital. We live about an hour from the hospital where I normally deliver so this story caught my ear. I was officially nervous.

I decided to investigate what options were available in my area and discovered my sister knew a midwife who lived FIVE MINUTES from my house. Five minutes?! Beat that, precipitous labor! We scheduled a meeting with her, asked a million questions, talked a lot to see what our comfort levels were, and decided to go for it.

Since we were going to allow the pregnancy to continue until spontaneous labor, I stopped working at 39.5 weeks. This decision, of course, caused a bevy of new problems since apparently the powers-that-be expect pregnant women to continue working until the baby falls out in the office hallway. In the past I have worked until the day of or the day before being induced so I had no idea the problems it would cause. It ultimately took seven months to get it all straightened out. I guess an institution with over 20000 employees is not accustomed to handling maternity leave.

My first day of maternity leave and I feel as big as the cows at the diary.

Anyway, I fully expected labor to begin within a day or two of stopping work. But it didn't. I hit my due date, still no labor. May turned into June. I wasn't supposed to still be pregnant in June! Our anniversary came on June 3rd with no real signs of labor. The unnerving part was that I really didn't know what to expect with a spontaneous labor. When Grace was born, the first sign of labor was my water breaking and real, no-doubt-about-it, active labor started within the hour. "They" say your water breaking first is not normally what happens so every pain and twinge caused me to wonder and yet nothing was happening. I reached the point where I began to believe I might be pregnant forever.
On the morning of June 4, 2013, at about 5am, I woke up to use the bathroom as usual and then climbed back in bed and went to sleep. All of a sudden between 7:30 and 7:45, I woke up to a gush of fluid. My first thought was, "I either wet my pants or my water just broke." I knew that I had emptied my bladder at 5 so water was the likely culprit. I got out of bed, went to the bathroom, and called for Dave to bring me the nitrazine paper to make sure. The paper was positive so finally at 41.0 weeks, the day had arrived. I put on the trusty Depends and began to prepare. I guess I'm one of those people whose water breaks first.
Conveniently enough, I had a midwife appointment scheduled for 8:30am. Dave called her to tell her my water had broken. She asked if I had any contractions (No) and said she would be there at the appointment time. Dave immediately called his mother to come pick up Olivia and Sam. Grace had previously decided she wanted to stay and maybe cut the umbilical cord. My mother-in-law must have been ready to walk out the door when we called because she was at our house within minutes. When faced with the prospect of her sister staying, Olivia objected. She wanted to stay too. Tears ensued. In a show of goodwill, Grace decided to forgo her cord cutting opportunity and go with her sister to keep her company. Hugs and kisses and then they all were gone before 8:30.
By this point I was having very mild contractions about ten minutes apart. I decided to sweep the kitchen and we finalize the name, Marian Josephine. When the kitchen was half swept, it was 8:30 and my midwife pulled into my driveway. She comes into the house and takes the preliminary vital signs: temperature, blood pressure, and pulse. Since there were no children in the house to clamor for their own, Dave made me cinnamon toast for breakfast. The midwife also wanted to time the contractions. She noted the time of the next contraction (8:45) and then started taking supplies out of her bag.
It was now that she discovered she only had one pair of sterile gloves. That's when the frantic phone calls began. She called her partner who lives an hour away. She called her husband to double check there were no more gloves at home. She called other midwives in the area to borrow from their supply. She finally found someone with gloves to spare and called her assistant to go and get them. The assistant was supposed to be en route to my house after she brought her children to a babysitter, but now she was running the glove errand. While all these phone calls were being made the contractions had been getting stronger if not closer together so sitting on the couch was uncomfortable. I moved my seat to an exercise ball.
After the gloves had been located and the assistant dispatched, my midwife turned her attention back to me, but I needed to use the bathroom. I don't think we ever got a good timing on the contractions. While I was in the bathroom, she continued unloading her supplies. When I was out of the bathroom, my midwife wanted to get a good, long reading on the baby's heartbeat. I sat on the exercise ball while she had the heartbeat on doppler for over ten minutes. The battery in the doppler started to die. It almost didn't make it the whole ten minutes. It stopped and started and blinked several times. She decided she had a good enough reading and stopped to change the battery. The heartbeat sounded really good! Just one brief and slight decel before bouncing right back to normal.
During the heartbeat monitoring, the contractions got a lot stronger and a lot closer together. I had to use the bathroom again. In a major departure from a hospital delivery, my midwife says, "If you feel like you want to deliver on the toilet, just let me know and we will work it out." I had a flashback. When I was in labor with Olivia, I was sitting on the toilet, taking my time and trying to prolong the time I was off all the monitors that required me to lie in uncomfortable positions. The nurse thought I was taking too long and came into the bathroom to scold me. I had better not deliver on that toilet! I needed to hurry up and get back in the bed. I laughed to myself thinking about the difference.
Now the contractions were real! I got off the toilet and moved into my bedroom. I knelt by the side of my bed while wave after wave of contractions came one after another. Transition and back labor were here. I must be destined to have horrible back labor with every delivery. My midwife tried rubbing my back. It felt great between contractions and felt like a special kind of torture during contractions. I pushed her hand away and couldn't find the words to tell her I wanted her to stop during contractions but keep going between them. She got up and continued her prep work. Hot water, some kind of herb bath, oxygen, and chux pads. I'm not exactly sure. The assistant still had not arrived so she was trying to do it all herself. I think she had Dave doing prep as well because I don't really know where he was during most of this time. He asked me once if there was anything he could do and I just looked at him. The midwife said there's nothing that is really going to help now. I started to feel a little pushy.
Realizing I was feeling pushy, the midwife encouraged me to do what felt good. Try pushing if I wanted or wait a little while. I tried to push a little but it didn't really feel right. The assistant finally arrived at about 10am with the steriles. I was still kneeling beside the bed. I don't know how long I spent beside the bed. I really missed the big hospital clock on the wall because it was too hard to turn my head and find the bedroom clock. At some point a kneeling pad like you'd use in the garden appeared. I felt like I was suspended between contractions and pushing and neither one was helping. They wanted to get another heartbeat reading on the doppler but it was still acting strange so no follow up. The assistant started giving counter pressure on my hips during contractions to take the pressure off my back, but nothing was helping. The only way out was getting the baby out of me. At last I started to feel like really pushing instead of that interminable pushy feeling that was only prolonging the agony.
I climbed into the bed on my hands and knees and pushed. I felt her head engage but it felt terrible. Usually when pushing, it hurts but it isn't unbearable. This feeling was different. I felt completely unsupported on my knees and needed something under me to help hold me, but I couldn't find the words to tell anybody. All I could do was groan. My legs collapsed so I was in a squatting heap on the bed. Dave all of a sudden appeared beside me and gave me his hand to squeeze. I pushed hard and groaned some more. I had never been this loud during delivery, but it felt awkward and painful. After three or four hard pushes, she began to crown.
One of my goals for this delivery was not to tear if it were at all possible. When Grace was born, my doctor cut an entirely unnecessary episiotomy in me against my will that took forever to heal. I have torn along that scar line for every delivery and have stitches on top of stitches. While Marian was crowning, they made every attempt to keep my skin from getting overtaxed. Whatever they were doing felt awful, but they were keeping me intact.
I waited for the next contraction to come to give one last push and her head was out. The source of the painful awkwardness was discovered. She had one of her arms over her face and her elbow was sticking out at an angle. She was already fussing. My midwife said she was in a strange position and I needed to keep pushing and not wait for the next contraction. I pushed as hard as I could with no momentum behind me, just brute force. After a minute or so, the rest of her body was out. Time of birth 10:40am; Weight: 8lb 2oz. Total time of labor from rupture until birth: 3 hours. I am always amazed at how you can be in such pain one moment and then almost normal the next.
The placenta detached and the cord stopped pulsing almost immediately. Rather than waiting on me to turn over, they slid baby back between my legs and laid her on the bed. Dave had to reach in to cut the cord while I hovered over baby. She stopped crying and looked around while I talked to her. It was a good thing Grace wasn't the one trying because I don't think she would have been able to reach. Now that we were officially disconnected, I flipped over and got to hold my perfect baby while we waited on the placenta. I started to shiver and they wrapped me in a blanket fresh from the dryer.

Just then our neighbor knocked on the front door in the next room next to my open bedroom window. He was looking to borrow a shovel! Dave had to tell him it wasn't a good time and I watched him beat a hasty retreat up the driveway.

Notice the open window.
Even though the placenta had detached, it wasn't coming with any speed. I tried pushing it out while in the bed, but nothing was happening. After nearly thirty minutes with my midwife getting antsy, she set up the toilet with a chux pad and we moved to the bathroom to deliver the placenta. I guess I needed a gravity boost because it came within a few minutes. Now that all the business had been attended, it was time to access the damage. The good news is that I did not tear along that old scar line. The bad news is that I did tear where that little elbow was sticking out. She said it was a good thing this was my fourth baby and not my first! After looking at it a few minutes, my midwife decided that it did not merit stitching. Baby was none the worse for wear given her odd birth position. They immediately started cleaning up, putting up, and starting laundry while I laid in the bed with baby. The house was empty again before 1pm and then we had lunch.

The part I loved the best about birthing at home was having the other children around shortly after the birth. I always have a strong desire to have all my children near me after giving birth, but it doesn't really work out in the hospital. There are the logistics of getting them there and once they are there, they have nothing to do in that small room, start getting rowdy, and then have to leave. At home, they were back at the house before 2pm. They could come visit me and baby at will and then run off and play. A downside to having the children around was by the evening, I was exhausted and ready for their wound-up selves to be somewhere else. Maybe we should have planned a sleepover for that first night, but we didn't think about it until it was too late.

I loved the postpartum period. The easy, relaxed atmosphere made the recovery so much simpler. Usually when I am released from the hospital, I am a bit of a hormonal mess. I have several days of moodiness and weepiness while the hormones crash. The stress of packing and moving and paperwork and unpacking must exacerbate the effects of the hormones. I still had the crash this time too, but it was not nearly as severe.
The actual birth itself wasn't the be-all and end-all I hear people talking about. I know some people revel in giving birth in their own bed. I thought it was nice, but not spectacular. I think some of my feelings come from managing precipitous birth. No matter where you are, home or hospital, there is some degree of hurry-up all around you. Everyone is so focused on getting everything ready for the birth that you, the actual laboring mother, get slightly ignored for awhile and generally that time is when you are feeling the most terrible. I thought a homebirth might mitigate some of that but not really. Another reason for my mixed reaction is the difficulty of the birth itself. I really had to physically exert myself (more than a usual delivery) so it was harder to enjoy. 

(I wrote most of this within a couple of weeks of the birth and one thing that surprised me over time is how often I would hold Marian in my bedroom and think about her birth. There is a real continuity there that my other labors don't have.)

Overall, the homebirth was a good experience and I would do it again if I was still medically suited for it.


bearing said...

I love the first picture of the two of you. She's such a pretty baby.

Jenny said...

That's one of my all time favorite pictures.

MrsDarwin said...

I agree. That picture of the two of you is the cuteness.

The Sojourner said...

Oh, it's the terrible elbow! I knew somebody had mentioned this in a Fb discussion of labor/birth but I couldn't remember who it was.

My mother's first labor was 3 hours start to finish, so with her second (me) she had a homebirth. I grew up thinking that's just what people did with fast labors.

Unfortunately, 25 years later CNMs can't do homebirths in my state and I don't think direct-entry midwives can carry Pitocin, so I don't think I'll be ditching my super awesome OB next time around. (I lost ~600 mL of blood with J, barely even a hemorrhage, and that was scary and draining enough; plus the whole peaceful homebirth aura would be kind of ruined if we had to call an ambulance an hour later.)

It's actually kind of nice to know that homebirths aren't necessarily these peaceful, relaxed experiences. My hospital birth was all you could ever want out of a hospital birth but I sometimes felt like I missed out on some sort of essential part of natural childbirth because there wasn't really a time when we were just in zone of working through it and anticipating the birth and whatever else it is people do. It was just "Oh, wow, those are some serious contractions" > call doctor > throw things in duffle bag > drive > sit in triage > ask L&D nurse to fetch things that I thought I might want > LOL nevermind time to push > baby > why won't this stupid placenta come out? > why won't this stupid bleeding stop? One thing after another.

Jenny said...

Oh yes, the terrible elbow! Not exactly part of the birth story, but it took me weeks and weeks to recover from all the bruising and effort required by the terrible elbow. This was my first delivery where it really and truly took the whole six week standard recovery period to start feeling normal again. Which made going back to work at nine weeks extra sucky. I had just gotten to the point where I could get up and walk around normally again.

CNMs can't do homebirths here either, but my CPM midwife had pitocin in her bag, so I guess that varies by state.

Precipitous labor is a weird process. There is no zone or room for any of that philosophical birth stuff you read about. You feel pretty normal, then you get run over by a Mack truck, then you feel pretty normal again. Sore, but normal. Psychologically, you are just hanging on during the ride, but it's a short ride.

The Sojourner said...

Yeah, physically I felt fine after giving birth. The nurses were all after me to describe my pain level and by about 24 hours out I was all, "What pain level?" (Granted, they had me taking a whackload of ibuprofen, but I think that still counts as bouncing back pretty fast.)

The first 6 weeks postpartum were really hard in other ways, but at least I could get around pretty well.