Sunday, January 27, 2008

Ruby's Birth Story--Three Years Late

A special thanks to my mom, who introduced me to how doable and preferable natural childbirth can be. Thank you for your example of peaceful laboring: I hope one day to be as good at it as you!

Also for Donna, who taught me and my husband the ins and outs of the truly daunting feat of accomplishing a natural childbirth in a hospital setting; without whose excellent education and guidance, we would have surely jumped the gun, ending up with many interventions I didn’t need.

And (the reason for posting a story so long after the fact) for Rebecca, my friend-through-blogging, who shares my (sometimes called “freakish”) interest in natural childbirth education with a passion very much like my own (from a few things I have read from your blog, Becca!), with the hope that your soon-due baby takes a much shorter—or at least less exhausting—time to get here than your first one did!

On Sunday, February 6, 2005 at 7:30 a.m. (5 days before due date), I woke to shower and get ready for church. I noticed a slightly pink discharge on a trip to the toilet, and the combination of that plus noticing several contractions during my 15 minute shower made me wonder if this could be “the day.” I woke Casey to ask if we should go to church or not (it is a 45 minute drive). The contractions I was experiencing were my usual Braxton-Hicks (B.H.) ones which I had noticed since the first months of pregnancy (despite what “they” say—that they don’t happen in the 1st trimester—especially with the first pregnancy—I began to notice B.H. before I was 12 weeks along). As the weeks closed in, contractions were longer, stronger and closer together, and it was not strange to be experiencing contractions less than 5 min apart, a minute or so long and attention-getting in intensity.

My midwife, Suzanne, had cautioned me on one of my last visits. I had had a very bad cold/flu 2 weeks before and at the next visit (1 week before), she noticed that I still sounded sick. With a little alarm (which I needed), she said, “You sound like you’re not completely over being sick. Labor is hard work and your body needs to be in good condition to handle it well. You are very close to your due date, which means that every day that you wake up, you need to ask yourself ‘Am I ready to go into labor today?’ and if the answer is ‘no,’ you need to alter the day’s plans accordingly. You need to rest up and get better right away.” (I am paraphrasing, but she was this strong and detailed about it. And though it was a lecture, she had loving concern in her voice, and I appreciated it and took it to heart.)

So Casey and I decided to stay home and rest/conserve energy in case I’d be going into labor that day. After going on a short walk while timing some contractions for ½ hour, he called our pastor around 8:30 or so to let him know we would not be at church so we could rest up. Contractions were 3-5 minutes apart and about 40 seconds to 1 min, 20 seconds long. This was our first, and we had no idea what to expect, but by textbook standards, that was pretty close to start out. By the timing of the contractions, some readers may be wondering why the next thing we did does not include careening off to the hospital at breakneck speed! But thanks to our wonderful childbirth educator, we didn’t rush to the hospital, since we had learned that contraction timing isn’t everything (nor is dilation, etc.). Just having close together contractions was not enough of a reason to go to the hospital yet.

We ran an errand to Wal-Mart to get a digital watch to time contractions more accurately (we’d been using my traditional watch—hard to do). We walked around the store, going down all the aisles we never had time to look in, timing contractions (which were 2-7 minutes apart and still about 40 seconds to 1 min, 20 seconds duration).

They were close together, but not any closer or stronger than I had noticed before. In the past 3 months I’d been having contractions pretty often, growing in intensity, as well as longer and closer together as the weeks closed in. (I distinctly remember going down one of the aisles thinking to myself “Why am I timing Braxton Hicks?” On paper it seems legitimate, but I had been feeling these exact contractions for a long time, I just didn’t bother to time them because I had no reason to think I was in labor. So I see a little bloody mucus and all of a sudden these might be labor contractions that I should time?)

When we returned, I rested for an hour, and didn’t begin timing again until almost 1 p.m. Contractions were 1-8 minutes apart, and 40 seconds to 2 min long. Around 2 p.m., on a trip to the toilet, I noticed more blood-tinged mucus, which I noted to be the mucus plug. (I was wrong: the real deal happened Mon. morning.) I hurried to look at my books for this other event, hoping to get a clue as to if I really was in labor or not. To my chagrin, the only book that helped me in this search was, What to Expect When You’re Expecting—I can’t stand that book! It had proven itself a completely useless waste of space and time up until then. {It seems to me that it is primarily the poorly informed mom-to-be who just loves this book—probably because it’s the only one she’s ever read—it’s generally the first book you’re given. I have never met a woman who really knows her stuff about pregnancy and childbirth who has said anything good about the book, and reviewing it recently, I think it’s because it talks to the reader like a patient who doesn’t want to be bothered with the details, not a consumer with a mind—and a choice—of her own. Saying things like: “Your Doctor may decide to . . .” or, “The hospital may . . . ,” etc., without information on other options, any pros and cons related to the subject, or even eluding to the idea that you have a right and (in my mind) more importantly, a responsibility to be part of the decision of what is done to you or your baby. I liken that book to childbirth classes offered by hospitals: their primary objective is to get you familiar with “the way that it’s done,” not to inform you of different options and the risks/benefits of each.} Even now, I cringe to admit that the book that I found the least helpful of any of the ones I had read was the most helpful when I was looking for a particular event. (Perhaps because of its layout it was easier to use as a resource.) Anyway, all that I found was that the mucus plug could be discharged even weeks before going into labor, and it was one of the least reliable signs of labor. Nice.

At some point, I called my Bradley teacher, Donna, to discuss where I was and what it might be. She said that contractions would be strong, close, long, and regular in active labor. If I wasn’t experiencing all 4, she said she wouldn’t count it as labor yet. (I realized later what a “by-the-book” person I tend to be, because they weren’t regular to me—all the examples I had seen in our class and in books were neat: i.e., exactly 5 minute intervals lasting exactly 60 seconds—very precise. By this standard, I was all over the place. I’d go 5, 1, 3, 2, 6, 8, 5 minutes between contractions, lasting :40, :40, :50, 1:55, 1:35, 1:40, 1:00. Only when I was pregnant with my second did I read that you’re supposed to make an average of what you’re timing, not take it exactly—making what I was experiencing: 4 minute intervals with contractions lasting 1 minute. That would have really been helpful to have known at the time. Do a lot of women just have “neater” patterns and not get hung up on this?)

Over the course of the next 2 days, I would try some Bradley “how-to-tell-if-it’s-really-labor” techniques: changing behavior to see if it affects the contractions. I showered, I walked, I drank something, I ate something, I lay down, etc. Contractions didn’t budge from their haphazard-yet-still-happening way. They didn't change or go away like they’re supposed to if it’s not “real” labor, yet they weren’t hurting enough, either (like one of Donna’s descriptions in class: “menstrual cramps times one thousand.”) From 3 p.m. to 5, they remained 2 to 6 min. apart, lasting 1 to 2 minutes long. They were getting longer, and around 3:45, on another trip to the toilet, I noticed bright red blood. But, I told myself, this isn’t labor. It wasn’t strong enough. I could remember having had menstrual cramps this painful (only a few times had my cramps ever been this bad, but even so, the pain I was feeling I had felt before, so it couldn’t be labor yet, right?).

Right after we went to bed at around 11 p.m. (our usual bedtime), the contractions started kicking it up a notch. {I can say this very definitely in hindsight. However, both that night and the next, I was not as keenly aware of labor progressing to a different level as much as wondering if I was just getting tired of it all and perceiving contractions to be stronger. “Is this water getting hot, or is it just me?” The proverbial frog and I both wonder.}

I lay very still and relaxed, fell asleep and tried to sleep through the contractions. When I no longer could sleep through them, I tried to sleep between them, but by 1 a.m., when I couldn’t do that anymore, I decided to change my activity level to see if things would slow down. I got up and got something to eat (a cup of yogurt & pack of peanuts and 12 oz of Red Raspberry Leaf tea.) The contractions didn’t change.

Around 3 or 4 a.m. on Monday, I woke Casey so we could decide if he should go into work or not. We called the hospital and talked to the midwife on call. She said we were welcome to come in and get checked, but we chose not to go in just yet, as I was still able to cope with the discomfort, so we figured I wasn’t very far along in labor (if I was in labor at all)! Contractions were very similar in timing to what they had been before.

About 5 a.m., we went on a walk to see if things would change. They did. The contractions got pretty mild again. When we got home, we took a nap from about 6 to 10 a.m., (able to sleep through them again at this point). Then Casey went to work.

That day, I stayed home, made some phone calls, cleaned some windows, and took a 45 minute nap. This was one huge downfall. In my mind, I was conserving energy, which probably would have been true had I slept through the previous night, but as it happened, From 7:30 a.m. on Sunday to when Ruby was born at 8:43 on Tuesday morning (over 48 hours), I had had a total of almost 5 hours sleep. (I don’t count when I tried to sleep through the really strong ones that first night, since they were close and long enough that I doubt if I got any quality sleep for the short while I was able to sleep through them.)

What I should have done was sleep all day on Monday (if my contractions would have let me). If I had known that I would get no sleep the next night, too, I would have made a better choice. However, I do think that my experience has its purpose, and it is a testimony to the fact that, even if a woman is sleep-deprived and her body has been working her to death (that is how it felt the second time things kicked into high gear—Enough! Either go or stop, but don’t tease me!), and she is so exhausted she sleeps between pushing contractions, it can still be done without interventions! {The biggest reason for this, I believe, was because we waited SO long to go to the hospital. Had I experienced this labor pattern there, the hospital’s arbitrary stop watch would have been started. They would have wanted to put me on Pitocin once the contractions slowed on Monday, which, if we had consented, would have probably been followed by my request for an epidural, and, because the two work against each other (Pit making the uterine muscles contract strongly and the epi relaxing the uterine muscles and making the contractions sluggish), it is well within reason that, after a cascade of more interventions—the “slippery slope of intervention,” as Donna calls it!—a cesarean may have been the outcome for "failure to progress" or a distressed baby.}

So, what I chose to do re: rest/sleep was due to the fact that I was thinking “maybe it was all in my head” about the previous night. I mean, labor doesn’t get going and then stop, right? So it must not have been labor, and I must just be a wimp to think that it was. I must have no idea what kind of pain I’m in for. I regret that I had these thoughts seconded by people I talked to in these 2 days of confusion. I was given the impression that there was no such thing as what I was experiencing (hence, I’m sure, validating the thought that I was imagining it—it never had been labor—it may be another week or more before I experience real labor).

From 10:45 a.m. Monday until 3:45p.m., (when I took my nap), contractions were 3-13 minutes apart, and 30 seconds to 2 minutes in duration (averaging 7 min. apart w/1 min. duration). Not a whole lot of change timing-wise, but they were back to my normal Braxton Hicks again in intensity.

After my nap, from 4:25 p.m. to 8 p.m., contractions were from 2-10 minutes apart and 45 seconds to 2 minutes duration (ave.: 6 min. between; 66 seconds long) . Wah wah—wah wah—wah wah. (Like the adults sound on Charlie Brown—that’s how I felt about this stuff by then.)

11 p.m. and we go to bed, and guess what? It kicks into high gear again.

I was not able to sleep through or between contractions this time, but, since this had happened the night before, I decided not to wake Casey (I wanted him fresh for when I was actually going to need him). {Another mistake I made: waiting to pull out the “big guns” until I went into labor—I was in labor!—I just didn’t believe it, because it was exactly like last night, which couldn’t have been labor, because it petered out. And I did need Casey. All the things I could have done: baths, showers, massages, encouraging words from my honey, or even having someone over who was experienced enough in such things to observe me and say: “This looks like active labor” would have made such a difference. As it was, I wasn’t relaxing this time, because it “wasn’t labor,” so I shouldn’t take these contractions so seriously. It would only make me crazy, getting my hopes up, only to be dashed in the morning when it petered out again. I wasn’t “letting go,” and “opening up,” like I was taught to do when I went into labor, because, like a broken record: “This isn’t labor.” and “This doesn’t count.”

A few months before, in one of our Bradley classes, there was a couple who had had a similar experience in that she was having contractions 3 minutes apart, yet didn’t have her baby for a month. I don’t know the details—did it come and go—or anything, but I had this in my mind as a distinct possibility. I could do this for weeks before “real” labor started. (Interestingly enough, almost this very thing happened with my 2nd labor, so it’s good to have had in my mind, but it really threw me off at the time.) From what we learned in our classes and the books I had read, what was happening didn’t fit any of the descriptions of what labor can be like. Even “The Putterer”—the description that most resembled my labor—was long and slow, but progressive nonetheless. It didn’t go backwards! Months after Ruby was born, I found a book that had the closest description of what I had experienced: called prodromal labor. Even up until then, I felt so alone in what I had experienced. Until reading an actual definition of what my labor was like, I had never heard of what had happened with me even being a possibility, and there was a sort of disbelief expressed when I would try to explain what my labor experience was like. I even wondered myself.}

I got a few snacks and tried to read things to find out if I was in labor or not. I was getting really tired of this stuff. I ate a few bites and drank a little hot tea, but became very nauseated, frustrated and hopeless. I was mad that I felt like I was going to die, yet I wasn’t even in labor yet. {Again, at this point, an astute outside observer would have been helpful here to recognize the emotional signpost of transition. Things were so slow-going and so long and drawn out that changes weren’t marked to me like they may have been for someone else. I think I may have experienced transition twice: once emotionally (and slightly physically) before we went to the hospital, and once primarily physically—completely devoid of the emotional signs—once we arrived in Triage. Because my labor was somewhat broken up by the trip to the hospital, it may have halted progress, then resumed once my body felt safe to proceed.}

Finally, at 3 a.m. or so, I woke Casey to let him know what was happening (or rather, that I didn’t know what was happening), and we called the hospital again. This time, I wanted to go, just because I wanted this to end. I gave up and admitted it: I was a wimp. There’s no way I could get through real labor if I couldn’t even handle this. I was going to need drugs after all.

Somewhere around 4 a.m., we left for the hospital. I was so happy and relaxed to think that soon I would know what was going on and I don’t think I had any contractions in the 15-minute drive. For the first time in 2 days, I felt great. The moment we parked and I opened my car door, I again started having close and intense contractions. I was still able to walk, though it was very uncomfortable {Another test I had learned about: if you can still walk through the contractions, you’re probably not in active labor. That may work well for your hypochondriac all the way up to your average person, but it’s not fool-proof—or should I say “frog-proof.” I am convinced I could have walked through the pushing contractions if at that point I somehow was still unsure if I was in labor yet! On the way to Triage, through gritted teeth, I frustratingly said to myself, “I can . . . still walk . . . through . . . these ones.” Hindsight makes me laugh at my literalness. And I’m sure there are other exceptions to this test, such as a fire, or some other catastrophe! It’s actually a little humorous to look back on, but boy, was it discouraging at the time! (Seeing a birth video after Ruby was born, I remember watching incredulously as the laboring mother stopped to rest for contractions very early on in an average-length labor—i.e. it wasn’t so fast-moving that they were incredibly intense contractions at that point. I thought to myself: “If she has to stop this early on, how is she going to make it to the end?” I guess that’s one of the luxuries of knowing “this is it!” from the get-go. But I have learned better since then: now I just relax during any bout of really strong contractions, even if I’m 25 weeks from my due date. However, if I stopped what I was doing each time I had a contraction, I wouldn’t get anything done for months!)}

I walked from the visitor parking lot to the elevators and onto the L&D floor, contracting all the way. I remember having a contraction as we reached the nurse’s station, casually hurrying to lean on the counter, trying to remain calm and not let on that I was struggling as much as I was. Nurses laugh at first-time moms who think they’re in the throes of labor and aren’t anywhere near. I was NOT going to be that mom. And I don’t know if it’s true, but something in me figured that if I came in all hot-and-bothered, they’d take me less seriously and actually slow the admittance process just to make a point. (You know what I mean, if you grew up with [or as] a sibling [or a bully!]. Someone shows a little too much feeling and suddenly, you know how to get to them).

{Most details of this story I wrote shortly after Ruby was born, but I didn’t have a good idea on many specifics once we left for the hospital. So, I ordered my records from the hospital, hoping to get some specific information to correlate with what I do remember. One thing I’ve learned from reviewing my chart is that at least some things that may be assumed to be factual can be more of a matter of the perspective of the person charting. Reading studies and statistics on such things will now be with a more critical eye for me. I will expound later.}

So, at 4:43 a.m. on Tuesday, I was shown to Triage, given a gown and a cup and went immediately into the bathroom to change and get a urine sample (whose idea is that?!?). Casey came in with me. About halfway undressed, I began to have monster contractions, causing me to lose last night’s dinner (into the toilet, thankfully), and, between violently vomiting, noticed that I was now also bleeding onto the floor. At this point, I was confused as to which end would be best to be over the toilet, so for a few minutes, I did a little dance, whereby switching vomiting, then bleeding into the bowl. All the while, despite the physical symptoms my body was going through, my emotions were on cloud nine: This MUST be labor! YAY! (I truly believe this was my physical experience of transition, though the numbers don’t agree.)

Once transition was over, I resumed getting into the gown and achieved a sample (which I had to apologize for, because I could not get a clean catch since I was bleeding). I then started to clean the blood off the floor, which Casey encouraged me to let them do. He was thinking a little clearer than I: sure that they had seen this before and that I wouldn’t be rude to leave it. I had a good reason to not clean up after myself today. He was right, but I was too embarrassed. Finally, after I had cleaned most of it, I was able to show my face to the nurses I was about to meet. (They had been checking on me, knocking on the door, wondering why it was taking so long for me to perform two small tasks. Casey had explained what was going on.) I didn’t want to bleed all the way to the bed, so they gave me a towel and I waddled over and we commenced the admittance routine, complete with external monitoring and a vaginal exam (the only one I would get!). Contractions were 2-3 minutes apart at this point; I don’t know how long they were. Unfortunately, my chart says nothing about what station the baby was, which was something I was really curious to know. But I was 100% effaced and 6 cm dilated. For many moms, this would have been devastating news: “All this time and only a 6?!?!” But I was ecstatic: “So it IS labor after all!!!”

Re: transition: many textbooks define the dilation from 8-10 cm as transition. It can be noted to be the most difficult part of labor—the time when many moms give up and want to quit. Most of the time, immediately after transitioning, a woman begins pushing. Even though after it was all over I was only a 6, the physical signs match the definition too well. I chalk it up to labor being different for every woman and stick to my guns on the idea that it was transition, despite the fact that I was a couple hours away from complete dilation. I think in this case, maybe a better definition of transition would be “expedient change in the cervix,” which is surely why I started bleeding so much so suddenly. Perhaps I was only a 4 when I walked in and 15 minutes later I was a 6. Who knows?

I was asked many non-labor questions upon being admitted, even though we had preregistered and the hospital had my medical record (somewhere—but my chart hadn’t made it the few hundred feet from where I had my appointments to where I would birth my baby). Things like if I had a family history of diseases, did I smoke, etc. I told them I was GBS positive.

The admitting nurse asked me when labor started. “Well, on Sunday. . .” I began. “No.” she interrupted. “Women are in labor for hours, not days,” She curtly stated. I was confused. “Oh . . . Hmm . . . maybe. . . well, by eleven last night contractions were strong enough that I couldn’t do anything but labor.” “THAT’S better,” she stated, typing away on the computer. I remember thinking at the time (and wish I had expressed something like it), “For a Triage nurse, it seems like you’d know better than to argue with a woman in labor,” but I kept it to myself. I am an easily swayed person when it comes to impressions and experiences that I’m confused about anyway: I will usually defer to someone else (especially when that someone has more experience or education than I do on a certain matter or is a “professional” in the field). Since she was the L&D Triage nurse, and she said it so emphatically, it must be true. Women don’t labor for days. Case closed. I didn’t bring it up to the medical staff again. (When my usual midwife discharged me from the hospital a couple days later, reviewing my chart, she commented, “So, a ten hour labor. That’s pretty good for a first labor.” I didn’t argue or give her the details about what actually happened. The message I had clearly gotten (again) was that whatever I thought I had experienced couldn’t happen, and therefore, I was imagining it. But I wasn’t totally sold: for months—and even somewhat now—I still was confused as to how long my labor was. It wasn’t ten hours, but how long was it?)

I mentioned earlier about reading studies with a more critical eye after having reviewed my chart. Two things stand out to me in particular about the way my labor was charted. One: first stage is reported to be 8 hours, 20 minutes. This is because I wasn’t allowed to have started labor on Sunday, because the nurse wouldn’t take that answer (not that I myself could say exactly how long labor really was). But if a research group were to review my chart to include in some average or statistic, it would be a far cry from accurate, and I wonder how many other labors are charted differently than they really are? The second thing has to do with pushing, and I’ll get to that when I get to pushing.

At about 5:45 a.m., I was shown into my room, got an I.V. for antibiotics (GBS), and given one dose of Ampicillin. After all my vomiting, I was concerned about dehydration (we had learned in class that the uterus doesn’t perform well if the body is deprived of nutrients or water), so I was drinking quite a bit between contractions. A young nurse warned me: “You might want to go easy on the water. It can make you throw up.” Sure enough, within 5 minutes, I was vomiting again. {I learned so many important things in my first labor on what NOT to do during active labor. Note to self for next time: lots of tiny sips is good, gulps are bad.}

I puttered around the room, rocked in the glider, rolled the birth ball around the floor, finally relaxing through contractions (since I now knew they were “real!”). The nurse who did my I.V. asked me how I would classify the pain I was experiencing from one to ten. I told him, “This is the worst pain I’ve ever felt in my life; probably about an 8.” I wanted to give myself room in case it got worse, which was totally a mental thing. Even if it was worse than any other pain I had experienced as of yet, if I was already at 10, where would I go from there, but drugs?

They finally got us settled. Casey ran to get our stuff from the car, then did some videotaping. We met the midwife on call (who guessed by observing me that I was about 9 cm. at this point. She was very encouraging. I wish she could’ve stayed!) and gave the staff a copy of our birth plan, since the copy I had put with my chart was lost wherever my chart was. I’m glad we were warned to bring a copy with us!

Immediately after this, I began to feel like I wanted to push. I asked the nurses (there were still at least 3 staff in our room at this point, fiddling with things) if they could summon the midwife so she could check me. She came in, along with the midwife who was taking over, who I also met for the first time. They told me that if I felt pushy, I should go with what I was feeling. No need to check dilation. So we tried a few different positions, moving around. The shift changed, and one of the nurses (the one who warned me about drinking too much) came to say goodbye. “You’re doing SO well,” she said. This was the last encouragement any staff volunteered the entire time I was in labor there. The new nursing staff we met (soon after she said goodbye) was all business.

Almost as soon as the new midwife took over, she expressed plans to break my water. As we had learned in our classes, Casey took the lead as my (and Ruby’s) advocate and asked what the purpose would be. “So I could see if there’s meconium,” she said. “And what would be the benefit to discovering it now, rather than later?” he asked. “So we could know ahead of time if we needed to suction the baby.”
After confirming that it was standard to have everything ready for any situation no matter what they already knew, Casey responded: “No, we’re not comfortable with doing that just for the convenience of knowing ahead of time.” She didn’t bother us about it again for awhile.

Okay, back-up to starting to push: I had practiced and had in my mind a squatting position, but as I looked around the cold, sterile room of tile and little that seemed comfortable, I didn’t know how to make this happen. I squatted over a sheet on the floor in the middle of the room for a few contractions, but with no support or way to rest between contractions, I didn’t last long. The midwives suggested the squatting bar on the bed and I tried that. It wasn’t much better. In order to truly rest between contractions, I would have to get out of my squat, lay back in the bed, and then—the really tough part—get back into a squat as another contraction came. Contractions were close enough that there wouldn’t have been ANY rest between them if I did all that, and I would wear myself out (I was already on my last ounces of energy). I needed a place to squat where I could stay that way, yet rest between. To trump it all, the midwives had advised me that for truly effective pushing in a squat, I’d need to curl my back into a “C” curve. Trying this for a few contractions, I could not do it. It caused my ribs to dig into my contracting uterus, which was extremely uncomfortable. I told them “It sounds silly, but this hurts.” But again, trusting the professionals, I did not say, “It hurts to do it that way; I’m just going to keep my back straight.” Instead, I just gave up on the squat, because I couldn’t do it the “right” way.

I ended up on my left side, pulling on a sheet tied to the squatting bar, Casey holding my leg up for every contraction. This was not ideal: I had to put my leg down in order to completely rest and relax between contractions, but surely it was not advancing the cause of getting my baby out to put my legs together! Nevertheless, I was exhausted and had no energy to try anything different (never could get used to the idea of lying on my back or “sitting” on my bottom while pushing, as so many people do). This went on for what seemed like an eternity, until my left hip was so sore, I had to change to my right side. {The second part about my chart that makes me raise my eyebrows: The time I was charted to have started pushing was at 7:20 a.m. While lying on my right side, it says I started to feel pushy. Yet, I expressed the desire to push before the 7 a.m. shift change, and experimented with several positions around the room before resorting to the bed, and even then, I started on my left side. Perhaps it was 7:20 when I ended up on my right side, on which I delivered Ruby, but I had been pushing for at least a half hour before the chart states that I started to feel pushy. Did my pushing not count as long as I changed positions? Anyway, second stage is reported as 1 hour, 23 minutes on my chart, but from what I can deduce re: the shift change, it was closer to 2 hours.}

Contractions were 3-4 minutes apart (chart doesn’t say how long). On my right side, a nurse took over for Casey and held my leg up during contractions, freeing him to give me spoonfuls of ice chips between contractions and hold my hand during them. I needed to look into his eyes for every contraction in order not to lose it. I was so overwhelmed by the exhaustion and pain (the former probably intensifying the latter). I felt completely out of control. Interestingly enough, even at this point of being utterly spent, the thought of an epidural was more scary than comforting to me. All I could think of was the fact that labor was so slow-going already, why would I want the possibility of drawing it out even longer? Not than an epi would have been available to me at this point, but it was the LAST thing I wanted to ask for (excepting, of course, the c-section).

Many women describe a part in their labor when they are so deep into what they are doing, they have no clue what’s going on around them. I have not experienced this kind of labor. Even being physically exhausted, I was still acutely aware of every sound. Physically I was at the end of my energy, but mentally, my mind was racing with thoughts; even when I was “sleeping” between contractions, my mind was awake and I was listening. It was my body that was resting.

Casey was doing his best to encourage me. He kept saying, “You’re doing great. You’re doing great. You’re doing great.” We were in the thick of things, and he didn’t have a huge repertoire stored away in his brain under the heading: “Things to Say to Encourage Your Laboring Wife.” (Verbal encouragement doesn't come naturally to him, so we had compiled a small notebook of Bible verses and relaxing thoughts he could review with me, but this was not the time to be juggling a book.) This was all he could come up with on the fly. I was so tired, so worn down, and the thing I needed most was communication, most especially the encouraging kind. There were at least half-a-dozen medical staff in the room, including the midwife, yet the only person who was telling me I was doing great was the only person in the room least qualified to do so. The stone silence from all those experienced people in the room screamed at me, “Yeah, right!” Finally, I cried out: “Does anyone else agree with him?!” Suddenly, several voices piped up: “You’re doing just fine.” Then we were back to stone silence again. Everyone was so busy fiddling and “getting ready” that it was as if caring for the actual patient was lower in priority to getting things done. No wonder the medication rate is so very high for laboring women in the hospital! No communication (and especially encouragement) takes its toll after a while. Far from what I had pictured when I chose a midwife to do my care, this midwife was not holding my hand, telling me I could do it, giving me hints on how to more effectively push, or ideas on things to try, or even telling me what on earth was going on with me or my baby. (I refer to her as an Ob in midwife’s clothing.) Periodically, she would get up from the stool at the end of my bed and leave the room without a word as to where she was going or when she would be back. (To believe the best: perhaps she thought I was the usual laboring woman who didn’t notice what was going on.) It told me I was nowhere near the end when the person who would be catching my baby left the room. I don’t begrudge her needing a bathroom break, or even needing to check on someone else in labor, or return a call, etc. The part that was so terrible was that she didn’t ever say anything. If she had only known how important an, “I need to check on another patient really quickly. Pushing is hard work, but your baby is getting closer. Just keep doing what you’re doing, and I’ll be back right away.” would have been.

Beginning when I started pushing on the bed, one of the nurses would hold the external fetal monitor on my belly, pushing it hard into the “smile” of my belly (right where the contractions felt the most intense) for every contraction. This added so much to my discomfort, I finally snapped, “Does that have to be on me?” “Yes,” she said. “We’re having a hard time hearing the baby’s heart.” At the time, I didn’t know that this particular midwife was monitor happy and there was absolutely no medical reason for constant monitoring to be necessary (Ruby’s heart rate was just as it should have been, it was that she was so low in the birth canal that it was hard to find her heartbeat—even that would have been an encouragement if someone had told me). I trusted that there must be a concern for the baby’s safety, and wasn’t about to argue with that. I was too tired to argue, anyway. So for every contraction, she would dig into my belly with the monitor.

For some of the pushing contractions, I would open my eyes as one started and tell Casey that I was “skipping this one,” meaning not pushing. I just didn’t have the stamina to push anymore. I may have skipped every few contractions near the end. I would try to relax through those contractions, storing up energy to push for the next one.

At 8:30, the amniotic sack was bulging. The midwife said so, and that she was going to break it to relieve some pressure. I didn’t waste energy arguing. Besides, I was feeling a lot of pressure. Sure enough, it did relieve a great deal of pressure. It felt so much better when she broke it. But it was definitely under a lot of pressure, too, as it practically exploded and soaked her front. Soon, they could see Ruby’s head, and asked me if I wanted to see it. I tried to picture how I would have to bend like a pretzel to be able to see it in my current position, so I shook my head, “no.” I didn't have a mirror in mind, nor do I think I’d take them up on it if I had understood. I didn’t want to see or touch her. I just wanted it to be over. Casey took a look and mentioned that we would meet the baby soon. I honestly didn’t care. I just wanted to be done so I could sleep.

While “sleeping” between contractions, I heard one of the nurses pick up the phone behind me and quietly say, “Could I have a baby Doctor in room 12?” Suddenly, hearing that, I knew I must be close, if they were bothering to call for the baby Doctor. But my energy was short lived. After what seemed like an hour of more pushing (but was only 10 minutes), I gave up (again). I told Casey I couldn’t do it anymore. I was too tired. The midwife, so very silent through the whole thing, said, “Just give me a couple more good pushes.” I pushed hard, a renewed sense that this might actually end soon. Another contraction came. I gave it my all, and Ruby Sophia came shooting into the world at 8:43 a.m. on Tuesday, February 8th. I saw a red blur rocket out of me in my peripheral vision; then I turned back and closed my eyes. “Finally,” I thought. “It’s over.” Because of my timing on giving up (or, more accurately, a lack of communication) I had a 2nd degree extensive (going deep into the birth canal) tear, as well as many small abrasions (they called them “skid marks”) inside me. To be gracious, I believe the midwife thought she was doing me a favor by telling me to give her really good pushes, since I was giving up, but the reason I was giving up was because I didn’t know what was going on and how close I was to the end. Her complete silence was so discouraging. Had I known I was that close, I could have made it those few more minutes, and it would have been much gentler on both me and Ruby. (As it was, it took weeks for the swelling to go down and my bottom to feel somewhat back-to-normal. I couldn’t stand for more than a few minutes without hurting for those first 2-5 weeks.)

I moved to my back and they put Ruby on me. (She had no name yet. It was between Ruby and Madeline. We decided to wait till she came out to see which name she looked like.) She was mad and tired. Seeing her and holding her, I had a surge of endorphins and started to feel better. I was still physically spent, but a better mental and emotional outlook was showing itself (by the fact that I wanted anything to do with her, for one!).

Another five minutes and the placenta was delivered (by the midwife tugging at the cord. We had requested a natural delivery of the placenta on our birth plan--it may or may not have been "natural." I don't know enough about this to discern if it was fine or not for her to do this. She was tugging, but not outright pulling). They did wait till the cord stopped pulsing, at least, to cut it. The nurses were very rough “kneading” my belly. I tried to nurse Ruby, but she wasn’t too interested, so we decided to let them do the newborn check while I got stitched. I was given a local anesthetic, yet I would have guessed that I was feeling everything. I can’t believe how difficult it is for me to relax for pain after the baby’s born. I was tensing and verbally expressive of the pain I was feeling (not quite yelling, but close) with every pull of the needle and thread.

Ruby was extremely red. (We joked that we’d have to name her Ruby because of it!) She was so red that during the newborn exam, they didn’t even notice an inch-and-a-half long strawberry hemangeoma (a birthmark) on her back. She was 19 ½ inches long and weighed 7 lb. 9.1 oz. Her APGAR scores were fine (8 at 1 min., then 9 at 5 min.), but she was as exhausted as I was. She was not the alert, undrugged baby we had expected after an unmedicated birth. In fact, I believe it took until she was a couple of months old before we knew she was actually looking at us!

Noticing the specific request on our birth plan to not have Pitocin after delivery, the midwife expressed a desire to do it anyway and we declined. She said I had lost about as much blood as she was comfortable with, so she’d be watching it closely. Around 9:30 a.m., the nursing staff told me I’d need to urinate before they could send me to the postpartum room, so I waddled to the toilet, on which I sat for a few minutes with nothing happening. I turned on the bath water. Still nothing. I kept feeling like I was letting it go, but then it wouldn’t come out. Finally, I told them I just couldn’t do it. As I started to stand, I passed out. A bunch of staff rushed into the room to help walk me to the bed. I was put on oxygen and Casey and I agreed to Pitocin. (At the time, we thought I had fainted because of blood loss, but as my home birth midwife reviewed my chart on my next pregnancy, she noted that 500 ml of blood is a normal amount of loss for vaginal delivery. She asked me if by that time I had been fed and given something to replenish my electrolytes. I told her no. “THAT’s why you fainted,” she said.) So, mistaking low blood sugar for too much blood loss, we consented to 2 things that we had not wanted: Pit and a catheter (the catheter because we believed it would be a bad idea for me to get up to try to empty my bladder the “traditional” way after already having fainted once). I don’t know how people can handle being catheterized. It was terrible. I never want to have to do that again.

Ruby nursed around 10 a.m. and latched on well. Sometime after 11:40, we were taken to the postpartum floor. Casey accompanied Ruby to the nursery, where she was bathed and returned promptly. (We had refused the eye ointment as well as the Hep. B shot in our birth plan.) I had an ice pack on my bottom (sweet relief!) and we just sat on the bed and held Ruby. Casey made some phone calls, and I asked him to make excuses to our pregnant friends and not hand the phone to me. I felt like a train had gone through me, and was thinking to myself that Casey had better be happy with the only baby I will ever give him. I felt so horrible and didn’t want to scare anyone who was looking at childbirth in the near future. I had NOTHING good to say about having a baby. I felt a little cheated. I had heard and read all these wonderful stories of non-drugged mothers and babies bouncing back from delivery, walking around (the moms, not the babies—“Wow,” I hear you say, “Natural birth is a miracle!”), feeling great. I have seen drugged moms and babies who fit that description more than we did, and I think our postpartum experience pretty much fit the description of a totally medicated birth—feeling groggy and out-of-it with no energy or spark, and pain being postponed until after the birth (though it wasn’t postponed so much for me as prolonged. It was a far cry from what I had heard a few strangers tell me about the pain being “over” when the baby was born. In some ways, it had just started). Even so, I was still glad that we didn’t compromise or end up with the major things we were purposing to avoid. I guess I want it to be clear that I do not regret going through with unmedicated birth, and that I really think it could have been an even worse experience if we had caved on some of the bigger things. Then I would have had to work through a lot more confusion and discouragement than I already did. It wasn’t natural birth that let me down: it was a lack of knowledge, support, validation and communication,--as well as my timidity--that made Ruby’s birth experience the harrowing one it was. I believe strongly that a couple can’t be too prepared for birth, which is why I still make a great effort to educate myself in regard to it (even when I’m not pregnant).

Around midnight that night, (after we finally decided on her name) I made myself shower, even though I had no energy for it; then promptly went to bed. Now that I think of it, I had not had more than 5 hours of sleep in a total of more than 64 hours. No wonder my outlook was so bleak and I felt so terrible! (The next morning, I felt so exponentially better than I had the day before that I began to think that maybe I could do this again, if recovery was this quick.)

Through that first night and the next day/night at the hospital, I fed Ruby for 10-30 minutes every 2 hours (sometimes more often). I had heard so many horror stories about breastfeeding (especially in the hospital), and refused to let there be any reason for a nurse to even suggest that Ruby needed to have formula or glucose water or needed to be taken away to the nursery. Whether it was a more laid-back hospital re:babies or that I was adequately prepared in what to expect and how to do it, I don’t know, but I’m happy to say breastfeeding was not nearly as much of a fight as I was prepared for it to be. But it was painful. I got blisters and blood blisters those first few weeks, and it pretty much always hurt, even though she was latched on correctly. Upon discharge, she weighed 7 lb. 1.4 oz.—she’d lost less than 8 oz, so my tiredness must not have affected the colostrum much.

Late afternoon on Thursday, the 10th, we were allowed to go home. Ruby showed no signs of GBS and her bilirubin count was fine. They wheeled us out (The hospital has a rule that no one may be both holding the baby and walking at the same time!) to the car, and off we went to start our new life as a family of three!

In the months that followed, I became much more educated re: birth, while trying to work out my confusing experience in my labor with Ruby. I decided to take all the things that I did not like about my birth experience that were within my “control” and make a better experience next time. It has almost become a game to me: “Now which things could have been better had they been done differently? How can I make the next labor even better?” I believe this is one of the main reasons (besides perspective) that my second experience was so much better than my first—because I learned from my history and didn’t have to repeat it! I am very thankful that God brought me through the difficult labor with Ruby and has used it for good, just as He promises his children (Rom. 8:28).