Tuesday, January 26, 2010

Planning an unplanned home birth

Now that I have reached that stage of pregnancy where I am much too large and uncomfortable to sleep, I have lots of late-night hours available to ponder the upcoming birth.

A few days ago, the paper carried a story about a woman who gave birth on University Parkway, a local road. "Are we going to do that?" I asked my husband.

"No," he reassured me. "We'll have our baby on 104th, or Redwood Rd., or 90th."

With roadside deliveries so rare, why do I even worry about this? I have two children, and in most ways their births were similar. They were each born a few days after their due dates, healthy and weighing 7 1/2 pounds. Other than gender, they even looked exactly the same. There was one important difference. My daughter, the first-born, had a "prolonged" labor and my son had a "precipitous" labor.

So, if I maintain this pattern, I will have this:
Baby 1: three days labor
Baby 2: three hours labor
Baby 3: three minutes labor

Of course, births are unique and may not follow predictable patterns, but I read the section on "emergency home delivery" aloud to my husband, just in case.

My First Labor

I started having regular contractions on Monday, one day after my due date. I reported to my husband that I thought I was in labor. He was dubious. "You don't appear to be in pain," he pointed out.

"I'm in pain," I countered. "I'm just happy that I might get this baby out."

That night, those irritating and painful (in a menstrual cramps kind of way) contractions kept me up all night. I timed them. They were rhythmic, coming less than 4 minutes apart and lasting almost a minute a piece, all the criteria of real childbirth contractions worthy of hospital admittance, according to my childbirth education class.

Halfway through 4 Hours of Pushing
and looking as miserable as I was.

There was one criterion the class failed to cover. "You don't sound like you're in pain," noted the nurse on the phone when I called the next morning. That stupid pain thing again! It hurt! Ouch already! However, she agreed that my symptoms sounded promising and told me to stay in the neighborhood of the hospital until I managed to achieve more pain, as it did sound like I would have a baby later that day.

So I stayed in the neighborhood.  I skipped work, painted the changing table and went out to eat. The day dragged on.  My pain was consistent, but never worse.  We had heard that sex can hurry things up, so we tried that.  It didn't.  We had heard that exercise helps, so I took a very long walk across the college campus and visited my husband's office on the thirteenth floor of his building--using the stairs, not the elevator.  Nope.  During my walk, I saw my neighbor, whose wife was due the same day I was, dashing off towards the hospital with a balloon bouquet.  Sigh.

At about nine at night, my mom called to see if anything was happening.  I moaned about my inability to feel more pain and she suggested I call my cousin, who taught childbirth classes, for advice.  I hung up the phone and was walking toward the computer to get her phone number when I doubled over in what was definitely Much More Pain

As soon as I could manage it, I informed my husband that I was ready.  He stalled.  He needed a shower.  He wanted me to wait!  So I did.  I turned on the TV to distract myself while I puffed and panted and paced through the contractions, which were definitely much worse than menstrual cramps.  Unfortunately, the only thing I found on TV was an episode of Rosanne that deviated from its usual sit-com format to explore a more serious theme in which one of Rosanne's daughters has a complicated childbirth.  Great choice for the circumstances.

We finally arrived at the hospital at about 11 at night.  The nurse examined me and determined that I was dilated to 3 ½ cm.  According to my childbirth education class, that meant that I was in active labor and admittable to the hospital.  However, since I had been dilated to a 3 at my last prenatal exam, the midwife was not impressed.  She sent me to walk the halls. 

During the walk, I advanced from “much more pain,” to “much, much, much, more pain.”  In an effort to distract myself again, we went to visit my neighbor, the lucky one who had already delivered her baby.  She was very gracious about accepting guests in the middle of the night.  My husband complimented her on her cute baby, she complimented me on the excellent way I was breathing through my contractions, and I was pretty much incapable of contributing to the conversation in any way.

At my childbirth education class, where they emphasized the non-necessity of the epidural, my husband and I had agreed that I would tell him when I felt I needed one, and we would then wait twenty minutes before actually getting one on the theory that I could put up with anything for twenty minutes. I had passed those twenty minutes by far before I was actually admitted to the hospital and medication became an option. 

At about one, the nurse examined me again.  She admitted that I hadn’t changed much, but she said that she would tell the midwife that I had dilated to almost 3 ¾ and that I was in a lot of pain and ready for medication, in the hopes that I wouldn’t have to continue the torturous walk around the hospital.

It worked, and at about two, I was admitted. Soon, I finally had an epidural and went back to the menstrual cramp-style pain I had become so accustomed to over the past few days.  Phiew. 

The midwife ruptured my membranes in an attempt to speed things up, and suggested that I probably wouldn't be ready to begin pushing until about seven the next morning and should get some sleep. I tried to comply, but I was excited. I called my family, who was excited too. In fact, my sister, the only sibling with kids and therefore the only one who hadn't become an aunt or uncle yet, was so excited she arrived at the hospital for the 7 am labor at about 5.

At about seven, the next shift's midwife announced that things were still slow and put me on Pitocin. Around ten, I was finally ready to start pushing. We put on some very pleasant music, positioned a mirror so I could see the triumphant arrival of my daughter, got the cameras ready, and prepared to meet her.

Meeting her was not forthcoming.  I spent four hours pushing, in fact. My epidural had eliminated some, but not all, of the contraction pain, which is good, because I had no trouble determining when to push.  Epidurals do absolutely nothing for the kind of pain you feel from complete physical exhaustion and that kind of pain grew worse and worse through this ordeal.  Imagine running a marathon, without training first, after two straight nights of not sleeping.

My husband, parents and siblings were there to support me.  I was at a teaching hospital, and the midwife and the nurse both asked if they could bring in trainees.   Sure, I said; I am not shy, and the more the merrier.  And since this labor went on for so long, the pediatric team arrived hours before they could actually do their work. My delivery room was probably one of the most crowded ever seen.  But that was good, because I really needed support--emotional and physical.  I had people cooling me down, warming me up, moving my legs, rubbing my back, and generally cheering.  Some of my family members who hold the priesthood in our church gave me a blessing. All of this was comforting, although nothing could actually make me comfortable.

As I got further on, I retained the ability to push, but sacrificed my ability to do anything else.  Between contractions, I laid there nearly comatose for those short breaks.  I was unable to focus well enough to even look at that mirror, where my baby's head  was visible each time I pushed for what seemed like, and maybe was, hours.

I asked the midwife if they couldn't pull her out--didn't they have a vacuum or forceps or something?  She said that would not be good for the baby and I was making progress without such tools.  I managed to see that mirror, with that head looking just the same as always, and wondered what progress she was seeing.  But I didn't wonder too much, because I was too miserable to think.

At one point the midwife brought in an Ob-Gyn for a second opinion.  He agreed that I was clearly making progress, albeit slow progress, and that I would eventually be able to push that baby out.  I was  outnumbered, because they both thought I could do it and I was not at all convinced.

After about four hours of this, at about 2 in the afternoon, the midwife fretfully and apologetically suggested an episiotomy to make more exit room for the baby.  Yes! Please! Anything that would get her out of me would be perfect!  I was much less squeamish about the idea than she apparently was.  And finally, that baby came out of there.

In movies, and I think, often in real life, this is where the mother, in spite of the pain and exhaustion, is overjoyed.  I was not.  I laid down, closed my eyes, and was hardly able to open them again.  I really didn't even see the baby.  As soon as she was freed from my too-tight birth canal, my husband and other family members abandoned my bedside and ran off to follow the baby, who I am sure was much cuter at that point then I was. While I wasn't sensible enough to see most of what was going on, it was still obvious that my husband was in raptures over the new child.  I think she had enough attention in spite of her mother's apparent indifference.  After she was examined and cleaned, the nurse brought her to me, which is when I knew I was supposed to cuddle and nurse her, but I tried to hold her and couldn't.  My arms were so weak and shaky I thought I would drop her and told them to take her away.  I was hungry, so I asked for food.  They brought me a sack lunch and with great effort I pulled out a banana. But I couldn't peel it.  I think that is when I started crying.  Not the tears of joy you're supposed to shed, either.

They moved me to the maternity ward and a cheerful nurse was giving me some sort of instructions.  I couldn't interpret them and I fell asleep while she was talking.  I slept for hours.  It wasn't until the next morning that I finally really met the baby and decided that I liked her.  I was happy to report this to my husband, who was shocked.  He had liked her immediately. 

During labor, the medical team had kept discussing how the baby was obviously very big for my birth canal.  When the head had first crowned, it appeared bald, so I imagined a bald, 10 pound infant. In fact, my baby was blond, so her hair wasn't visible until she was washed, and the biggest shocker--weighed in at exactly 7 1/2 pounds, the average baby size.  That baby was not big.  Apparently, my birth canal was very small. All the medical staff assured me that by getting the baby through, I had stretched out the exit path and my next delivery would be much easier.  I could not imagine ever doing that again.  But I did...

My Second Labor
This is a much shorter story, because it was a much shorter labor. My second baby was due on Thanksgiving day, and several relatives who lived out-of-town were anxious for the baby to arrive on Thanksgiving weekend so they could meet the baby before returning to their homes.

By now, I was experienced at giving birth and knew that it was a three-day process for me, so when nothing had happened by the end of the holiday, I let my family members know they would have to wait to meet the baby on their next visit.

The Saturday following Thanksgiving, my husband, my daughter, myself and my mother-in-law (who was staying at our house for the holiday and the birth) were up late watching "Hairspray". At about 11 at night, my husband jostled the surface I was sitting on and I felt something wet. I ran into the bathroom to see what was going on and my very curious and speedy two year-old daughter raced in after me, arriving so close on my heels that I couldn't close the door in front of her. She was there to witness myself examining the small flood I was creating.

My husband had explained the birth process to her earlier and she had wisely chosen not to believe him. It was apparent to her that Mommy did not have a hole large enough to eject a baby from her vagina.

However, seeing is believing. "Daddy, Daddy, the baby is trying to get out through Mommy's vagina and he's making lots of water!" she yelled.

Since we now had Daddy's attention, I asked him to bring me a clean pair of panties and a maxi pad.

A minute later, I asked him for another clean pair of panties and another maxi pad. This is when my mother-in-law, who had experience with this sort of thing that I lacked, suggested that my husband stop this silly maxi pad effort, get me a big towel to wrap around myself and take me to the hospital.

The towel was certainly more effective than the pads had been, but I still questioned the advice to go to the hospital. I was in no pain at all and I had learned last time that lots and lots of pain was a definite prerequisite to hospital admission.

So I called the doctor. I reached a machine, which said, "If your water has broken, report directly to the hospital."

Okay. So we grabbed the suitcase and got in the car. During the short drive, I started to feel the menstrual cramp-type pains that had plagued me for two days last time. When we arrived at the hospital, they really hurt, so I asked my husband to help me in and get the suitcase after, and if, they had admitted me.

"Your water has broken!" said the cheerful nurse at the front desk, looking at the slip of paper I had filled out specifying my reason for coming to the hospital. "Did you have a big gush?"


"Have contractions started?"

"A few minutes ago."

And I was suddenly and magically admitted: no cervical exam or adequate pain necessary.

As we followed another nurse to the delivery room, we asked if my husband could go home and take a nap, and if so, when he should be back to coach. (We both had agreed after the first time that it would have been better for him to have gone home and gotten a good night's rest before nearly a full day of coaching.)

The nurse stopped and stared at us for a few seconds like we were absolutely nuts, then said, "Don't go home. You're having a baby."

She quickly recovered and redoubled her efforts to get us set up quickly for delivery. It seemed like an unnecessary rush to me and I tried to reassure her that she could relax since I was so slow at giving birth. She was not convinced. Her judgment proved better than mine, because within seconds after getting into my room I had advanced to that level of much, much more pain.

The nurse was frantically, and unsuccessfully, trying to get the doctor and the anesthesiologist into the room, and it seemed that every few seconds she announced that I was dilated another centimeter wider. It hurt, and all of my comfort tools--the music, the back massager, the heating pad--were stuck in my suitcase in the car, and of course there hadn't been time to get my mom or my sister over there. I desperately glanced over at the monitor at one point to see why I couldn't feel the lull between contractions and I saw one long line spanning the top of the screen, without ever dipping down at all. The nurse saw me look and shook her head sympathetically before calling the anesthesiologist. Again. She scolded whomever she was speaking to over the phone and told them it would be too late if I did not get an epidural right now.

The anesthesiologist finally did show up and admitted that a few seconds later would have been too late. I had a spot that still hurt, but there was no time to fix it and since I felt so much better than before I was not complaining. A physician arrived--not mine, whom they hadn't been able to reach. He apologized because he did not think they would be able to get my doctor over on time. "Will you catch the baby?" I asked. He assured me that he would, and I was satisfied. As long as the poor child wasn't left to fall on the floor, I really didn't care who caught him.

No Time for Pictures During This Labor
Here I am afterward, with my daughter meeting
the baby and stealing his bink for the first time.

Now that I had a doctor, it was time to push. I braced myself for a few hours of pushing, but about twenty minutes later, I was startled when the doctor tossed the baby into my lap. "He came out already!" I exclaimed.

It was about 2 am--three hours after my water had broken. I was not even tired! I got to enjoy my little newborn. My husband, wiser from experience, checked with me to see if I needed his support before he took off to follow the baby through his bath and exam. I told him to go ahead--I felt great and I was alert enough this time to watch too, from across the room.  And then they brought the baby back to me and I had no problem at all cuddling and cooing and nursing him.  My parents came over shortly thereafter to meet the new grandchild and the rest of the family came in the morning, before anyone had to get out of town. I was ready and able to visit, not nearly comatose like I had been for the first 24 hours after my first child's birth.

Fast or slow, birth hurts, but fast is definitely better.

1 comment:

  1. Um honey, LeeAnn here,
    I was going to tell you that you shouldn't plan on such and such happening b/c it never quite happens that way, but now I don't know what to tell you....other than I hope it's not a 3 minutes birth...hang in there. The picture of you half-way through labor with your daughter just about killed me...you look like you are in so much pain.
    Hang in there, you tropper. You can do it!