Some background...
For me, labor and delivery support options were in effect limited to
two hospitals, one very small and 5 minutes away, one medium sized and
45+ minutes away. Being a first-timer, I wanted to be attended by a
CNM or an OB, preferably a CNM. A home birth was available but only
with a direct entry or a lay midwife. Only the very small hospital
had a CNM on staff, but she might not be available for my delivery,
and several women I know who delivered there told horrific stories of
their deliveries involving nearly bleeding to death (another woman
did bleed to death!). On the other hand, the OBs involved in those
deliveries had since left the practice. In the end, I chose the CNM
at the small hospital because several more women I know who delivered
at the larger hospital had C-sections due to failure to progress with
posterior babies. These women were grateful to their OBs for saving
them and their babies, but to me their birth stories were tales of
callous torture by indifferent OBs who expected to solve any problem
eventually by C-section. None of the women knew about turning a
posterior baby in utero, and for none of them was a version even
attempted.
My top three fears were: #1 bleeding to death, #2 heavy-handed
medical interventions (particularly epidural or spinal taps, which I
hate) culminating in an unnecessary C-section, and #3 unmanageable
pain. #1 is low probability, even with an indifferent or incompetent
OB. #2 I knew I could mitigate by educating myself, by selecting a
midwife or OB who is not an interventionist, and by refusing unneeded
interventions. #3 was my least concern but took the most time to
research. By far the most helpful source, apart from birth stories
in m.k.p., was Robert Bradley's book "Husband-Coached Childbirth".
Although I think his Bradley Method is mostly a load of crap (and the
patterned breathing of the Lamaze Method even more so), I agreed 100%
with his point that minimizing fear is vastly helpful. I also read
Gray's Anatomy, and studied the illustrations carefully. I concluded
that most of the advice given women about when and how to push the
baby out is another load of crap! The specific muscles that push the
baby out are not under voluntary control, so the most useful thing the
woman can do is *relax*. Relaxing helps both muscles that are under
voluntary control and involuntary muscles (particularly the cervix)
that absolutely must relax to allow the baby to pass.
Now the story begins...
I went to work as usual on Wednesday March 24. My EDD was a week
away, but I had been slowly clearing the decks at work so I had not
much to do apart from the most mentally hard work. For some reason,
hard work was even harder to do than usual: perhaps because of the
almost constant contractions. I had been having very strong, very
long contractions for the past month. They were only occasionally
painful but usually lasted for 10 minutes or more. My uterus was firm
to hard as a rock almost without pause, rarely soft. That night DH
and I attended the last class of our childbirth course, then I went
straight to bed. Just in case my water might break one night in the
coming week, I put a rubberized flannel pad under the sheet beneath
me. Did I have a premonition?
At 11:30 I woke and headed for the bathroom. Normally I sleep through
the night but for most of the pregnancy I had to get up once a night
to pee. This time, though, I felt a new ache low in the right side of
my groin. As I entered the bathroom in the dark I felt a "pop" at the
site of the ache, and fluid gushed out of me. I turned on the light,
imagining I might be bleeding to death (!), but the fluid was clear.
I was not sure what had happened, in part because I was not entirely
awake, but also because I had trouble peeing. I mopped up the worst
of the mess, then went back to bed. There, I said to DH "I think my
water broke". Silence. After a few minutes I said "Did you hear me
say my water broke?" He answered "You said you *thought* your water
broke". More silence. I thought for a few more minutes about what to
do. My midwife (the CNM at the small hospital) had told me to stay
home until the contractions were less than 5 minutes apart but the
childbirth course instructor, a labor/delivery nurse at that hospital,
had told us all repeatedly to go to the hospital immediately if water
breaks. Then I realized I was having a contraction. In fact, it was
*another* contraction, which meant the prior one had been very short!
Just like a regular labor contraction. So, after another long pause
I continued to DH "Well now I am having contractions. I think it is
time to get dressed and go to the hospital." That got a reaction.
We rolled out of bed and I called the OB ward to report my water had
broken and I was having contractions 6-7 minutes apart, so I was
coming in. They said we should take our time. I had made a minimal
list of stuff to pack (books on tape, tape player, snacks, etc.) but
had not actually packed it. So we did that. But I had a peculiar
sense of urgency, so to dress I only put on pants and shoes under my
nightshirt.
The trip to the hospital was very uncomfortable for me! During the 5
minute drive I had 2 or 3 contractions, and they were becoming quite
emphatic. It was nice to have a break after each one. We had been
told that at night we should enter the hospital through the emergency
entrance. DH dropped me off by a sign that said "Emergency" and went
to park. Meanwhile I found no emergency room and no hospital staff,
only an unlocked side door. I went in...into a construction site.
That is a generous interpretation of the scene. Very surreal. Some
men in civilian dress were lounging around chatting; they looked to
me like patrons of a seedy bar. Trash everywhere. Naked lighbulbs.
No staff or other evidence consistent with the place being a hospital.
I found an elevator and took it to the OB floor in the correct
universe. There a nurse showed me to a huge room with a small
hospital bed, and told me to put on a hospital gown and get comfy in
the bed. Hah hah. She left. The bed had two built-in inflatable
cushions that were inflated and would not deflate. It was amazingly
uncomfortable. DH arrived. Time was 00:30 Thursday.
More nurses came and hooked me up to the external monitor machine.
That took a long time as they had trouble getting a steady signal of
the baby's pulse. Baby had been in perfect position, head down and
riding low, for over a month. This, plus my non-stop contractions,
had made it difficult for the midwife to feel the baby or hear a good
pulse on the Doppler, so each weekly check-up involved a very quick
sonogram. I knew without a doubt baby had not moved from position.
Fussing with the monitors, the nurses told me to hold still, which
grew increasingly intolerable. One started to prepare an IV but I
suggested she wait until it was needed, and she stopped. Eventually
I mentioned the fussing was starting to make me anxious and in any
case (ahem) the contractions were now running 2 minutes apart. Then
they asked about my last internal exam; I said I had not had any,
but that for weeks I had been feeling sensations consistent with my
cervix stretching. So a nurse checked and reported it fully effaced
and 6.5 cm dilated. Then there began a big rush to call the midwife
(only nurses were on duty that night; it is a very small hospital)
and bring in equipment carts. About then my contractions became far
more intense, and I started to zone out and ignore almost everything
going on around me.
I realized that if I wanted to wait for the midwife I would have to
resist the urge to push, which was already mounting. I suspect my
knowing this contributed to the pain of the contractions. I held the
headboard of the bed and with each contraction I rocked, pulling and
pushing against the headboard, groaning (which at some point segued
into yelling). That was the only motion I could find to satisfy my
need to move without disturbing the damned external monitor. Soon, I
began also clamping my knees together, to keep from pushing. After
maybe 10 more, increasingly intense contractions, I realized the last
two contractions were milder. I was already in the transition stage!
About then a nurse asked me to rate the maximum contraction pain on
a scale of 1 to 10; I said it was an 8. (For years, I had suffered
excruciating pain during my periods; that pain was my 10.) Although
DH said later that he felt mostly extraneous, he was a big help here,
reminding me to breath, breath slower, relax. I announced I could
not wait much longer and if I opened my knees the baby would shoot
out across the room. The nurses seemed to think that was funny.
Somewhere along in here the midwife arrived, got prepped, and checked
my cervix. Soon she said I could start to push, so I did. I upset
the external monitor so the band monitoring my contractions came off.
Entirely out of character for me, I shed the hospital gown; it was
contributing to the annoying fussing over the fool monitor. The band
monitoring the baby stayed on longer, until the nurses began to fuss
about the baby's pulse dropping below 100 during contractions. One
nurse startled me by putting an oxygen mask over my face. It made me
feel claustrophobic and really broke my concentration. I moved it to
cover just my nose, then the midwife told them to take it away and
also take off the second monitor band. She said the baby's pulse was
dropping due to head compression, perfectly normal.
With the external monitor removed at last, I was free to get up and
squat. They installed a cross bar for me to lean/hang on, and the
midwife and DH rubbed my back too, which felt wonderful. I squatted
until my thighs cramped, then leaned back against the bed (it had been
raised into a chair configuration) while the midwife and one of the
nurses massaged the cramped muscles. Relief! The bed had hand grips
on each side of my hips that I used to hold myself up in the bed. The
inflated cushions in the bed made me feel as if I would slip off if I
did not hold myself up. DH says this stage lasted about half an hour;
I am glad it was not longer because holding my position was tiring. I
wish my position in the bed had been secure enough that I could free
up one hand to feel the baby's head as it emerged, but I am glad I was
able to maintain a good upright, semi-squatting position for the full
time I was permitted to do so.
Baby started to crown and the midwife applied hot wet towels to my
perineum: more relief! Near the end I said I thought I was tearing
but the midwife assured me it only felt that way (but see below). The
tearing sensations were exquisitely painful yet brief, and I knew the
end was very near. In any case, the pain was a productive kind, not
something to be feared. Then baby's head was out, the nurses dropped
the back of the bed, and I laid back while baby finished coming out
and they put him (!) on my chest. Time was just short of 02:00, so
the entire labor and delivery took about 2.5 hours.
DH was beside himself with excitement, and speechless. He held my
hand. I said only "Oh my" and "Yep, a boy." We had asked not to know
the sex but every sonogram gave it away; boys tend to be so obvious.
His color was a deep purple, as expected given the altitude here, but
he was breathing and moving and making faint squeaking noises. (His
Apgar scores were 7 and 9.) A nurse suctioned some goo from his mouth
while I stroked him and felt amazed. DH declined to cut the cord so
I got to do it. I expected it to be rubbery but I was very surprised
that it was transparent! This has led me to reflect for some hours on
the evolutionary history of transparent flesh, which today is mostly
restricted to deep-sea animals and to the early embryo stages of land
animals. Once the cord was cut, nurses put him in a small portable
incubator with oxygen while they cleaned him up a bit and suctioned
him some more. DH thought DS was not breathing and waited anxiously
for him to start crying. DS obliged, a little; he is not a big cry
baby.
The placenta was delivered uneventfully and intact; to me it looked
large and healthy. There was one small "dead" spot, I suspect where
DS had been in the habit of pressing a foot against my ribcage. I
was sore there for the final three months of the pregnancy.
I was ready to go home 12 hours later, but hospital protocol was to
stay 2 nights for observation. Ironically, just after the day shift
ended and the MDs went home, there arrived a flood of women in labor
and suddenly the nurses were eager to have me go home. Too late! And
too bad for me; I wanted to go home early because I could not sleep
in the hospital. I kept DS with me the entire time, which contributed
indirectly to the problem. Between the very uncomfortable bed and
constant disruptions from nurses and others coming in to do routine
temperature and blood pressure checks on me or DS (each check done by
a separate nurse!), orderlies, and DS himself, I was soon exhausted.
If a stranger enters a room where I am sleeping, I *will* wake up. I
asked for a do not disturb order on my chart, but apparently the order
was written as "do nothing", which at least one nurse took to mean "do
not discharge"; most of the nurses continued their routine checks.
Finally, we went home the next morning, after a total of 34 hours in
the hospital.
Looking back...
Full term at birth 38 weeks, 5 days from his probable date of
conception, DS weighed 5 lb 13 oz and was 18 inches long (2.6 kg, 46
cm). He is a little Monkey Boy, very active, with big hands, feet,
and head. Weight and length were at or below 5th percentile, but head
circumference was 25th percentile. Now, at 3 weeks, he is 6 lb 14 oz
and 20 inches (3.1 kg, 51 cm). At birth his nose was badly mashed to
one side, perhaps due to his riding low in my pelvis for weeks. The
nose is gradually becoming straighter, but still has some way to go.
I was surprised to realize after the fact that during the entire labor
and delivery no thoughts of getting pain relief ever crossed my mind.
I didn't even think to ask for an analgesic after the delivery. But
then I was only mildly sore, for only a couple of days. Perhaps this
is because I waited for the contractions and when I felt one building
I allowed it to build. Pushing consisted of nothing more than letting
go to help it along. I would not say that I pushed the baby out; my
body did it and I was mostly an observer in my body.
My perineum did not tear, although there was some swelling and a few
"skid marks". I am glad to have dispensed with the added injury of an
episiotomy. Unfortunately, I did suffer a small internal tear: I have
nerve damage that has caused partial paralysis in my perineum and
urinary stress incontinence that at first was complete. I was shocked
and devastated by this outcome, but the midwife says that significant
incontinence is very common, although it is more common after slower,
more difficult deliveries. The incontinence is slowly getting better,
and now I feel confident of an eventual complete recovery.
Although I had asked a friend, a CNM affiliated with a hospital not
available to me, to be our doula, she lives over an hour away. So,
given the abruptness of my delivery, there was not enough time to call
her. But even though the labor and delivery were easy and I was very
happy with the midwife, a doula would have been helpful for improved
communication with the nurses!