Monday, October 11, 2010

Birth Story of the Week: Things Can Be Different the Second Time Around

This week's birth story comes from one of my oldest, dearest friends, Haley. Haley and I met through a local homeschooling group in Mississippi when we were thirteen and were instantly bonded for life through our mutual loves of writing, coffee, early 90's moody folk/rock albums (anyone remember Automatic For the People, Swamp Ophelia or August and Everything After? We had all the lyrics memorized backwards and forwards) and epically giggly marathon-length phone conversations (we still launch into that same giddy cacophony when we get on the phone to each other, all these years later).

Haley is one of the most hysterically funny and brilliantly smart writers I've ever met, and her birth stories are as entertaining as they are enlightening and touching. What follows here is her account of the recent birth of her second child, which was originally posted on her blog. I encourage you to read the prelude to the story, here, which gives some terrific background on Haley's decision to have a midwife as a care provider in this pregnancy, or as Haley put it, "Why I Broke Up With My OB."

Without further ado, here is Haley's story. Thank you so much for sharing, my friend!
--Leigh

At 3 a.m. on the morning of April 23, Dan and I walked out of our house into a freezing cold spring night and got in the car, on our way to the hospital to meet our son. At 5:22 a.m., two hours after we arrived at the hospital, Isaac was born. It is no exaggeration to say this is the story of the craziest, most intense two hours of my life.

First, let's back up to 2 p.m. the previous afternoon. I had my 39 week appointment with my midwife, who told me that I was 3 cm dilated and 75 percent effaced. I had been having contractions of varying discomfort levels for weeks, so while I was glad to hear that I was making some progress, I wasn't convinced it meant I'd be in labor any time soon. I went six days past my due date with Kate and was prepared to wait this time. But it wasn't like I was happy about it. The last month of the pregnancy felt like a slow march through thick mud. I was exhausted, huge and ready to just have this baby already. So when my midwife offered to do a membrane sweep to help things along, I was all for it. As I left the appointment, my midwife had me set up an appointment for the following week. "But I'd be surprised if you don't have a baby before the weekend is over," she said. I laughed. Clearly she had not paid attention when I told her how I go way past my due date. Silly midwife.

When I started having regular contractions a few hours later while fixing dinner for my mom, Dan and Kate, I still wasn't convinced this was it. As was the case with Kate, I had a bout of false labor a few days before, and I knew that these kind of contractions can stop just as suddenly as they start. So we went ahead with our usual evening routine of dinner, a bath for Kate, bedtime singing and stories.

By the time Kate was down for the night around 7:30, I was still having contractions, so I figured I might as well get a few things done around the house and round up the remaining things I'd want in my hospital bag if we went that night. Since I had made a great little labor play list, I put on my i-Pod and listened to that while my crazy pregnancy hormones made me clean the bathroom and the contractions got stronger. When I was done with that, I went in the living room and sat on my inflatable exercise ball and folded laundry while Dan and I watched The Office and 30 Rock. Both were exceptionally funny, and I was still comfortable enough to have a sense of humor. I laughed a lot, which I figured was not a good sign for real labor being anywhere in sight. I seemed to recall my sense of humor failing me when the real pain started last time. So I told my mom and Dan that we should all just go to bed. Sure, the contractions were still happening, but I'd wake them up if there was anything we needed to do about it.

Notice how incredibly boring this story is so far. I'm about to fall asleep reading it. I'm sure you are too. Trust me when I say that things got more interesting soon. But first everyone, myself included, went to bed around 10. I actually slept off and on while still having contractions strong enough that I'd notice them before I'd fall back asleep. Then around 1 a.m. I realized that for a half hour or so I had been awake more than asleep and was starting to feel like the contractions were intense enough that I would deal with them better if I got up. So I did.

Now a word about my birth plan. Having spent about 10 hours in Triage Hell when I was in early labor with Kate, my goal this time was to spend as little time at the hospital as possible. It's not like the contractions were going to hurt any less at the hospital, I reasoned, and I'd rather just be at home until I was ready for someone to give me some drugs. And I did want those drugs. As I mentioned in the prequel to this birth story, I had done a lot of reading about childbirth in the wake of Kate's birth, both educational stuff and actual birth stories. The things I read advocating natural childbirth had made a big enough impression on me that I seriously considered trying to go without an epidural this time. There seemed to be a lot of evidence to support the idea that the ability to choose a delivery position other than flat on your back could make the delivery easier on the mother, and that made sense to me. But here's the thing: I am a total wimp about pain. Seriously. And every time I'd try to think about whether I could handle natural childbirth, I would remember that fact and laugh at myself for even considering it. So I would labor at home as long as I could, which I figured would be about ten minutes, and then I'd go to the hospital, get some drugs, and read a book until it was time to have the baby. When people would ask about our birth plan, I'd always end with "Unless I have some crazy fast labor this time." And then I would laugh.

So now it's 1 a.m. and I'm hanging out in our spotlessly clean bathroom, breathing through contractions. They really did hurt, but maybe because I had just recently been asleep and was relaxed and all alone in the quiet of the house, I was not feeling too stressed out about them. I brought my exercise ball into the bathroom with me and was sitting on it, resting between contractions, and not thinking about very much at all. I also wasn't timing the contractions, just noticing in a vague way that they were getting closer together and longer. When I was pregnant with Kate, Dan and I took a childbirth preparation course and our instructor said that if you can comfortably talk through contractions, you're probably not that far into labor. "That's a nifty piece of advice," I remember thinking. And it is. Unless you're by yourself and not trying to talk to anyone. This is what I learned around 2:30 a.m. when Dan woke up. We'd had had a brief chat when I got up from bed around one. I told Dan I was getting a little uncomfortable, but that I didn't think it was going to be time to go to the hospital anytime soon, and to go back to sleep while he could. So an hour and a half later I walked back into our bedroom to get something off my nightstand and woke Dan up when a contraction started and I was leaning on the bed breathing through it. When it was over, we had the following conversation:

Dan: "How far apart are these?"
Me: "I don't know. (I throw my cell phone in his general direction with perhaps a little more force than necessary.) You time them."
Dan: "When are we supposed to call the practice?"
Me: "When they are about three minutes apart."

Two contractions later, Dan determined that they were three minutes apart and maybe a little less than that. So he got up out of bed. Another contraction started and doubled me over.

Dan: "I think I'll just go ahead and gather up a few of the things we need and ..."
Me: "OH MY GOSH SHUT UP! JUST SHUT UP!"
Dan: "Yeah. I'm calling the practice now."

Clearly we had passed the able-to-talk-through-contractions stage at some point I failed to register and had entered the irrational-yelling-at-anyone-who-dares-to-talk-during-a-contraction stage. This did not make our phone conversation with the midwife on call for our practice go very well. Dan was on the phone trying to answer questions, and any time he would ask me something I would tell him "I don't know!" or the ever-so-helpful "Don't talk to me!" Somehow it was concluded that we would just come on in to the hospital.

Dan went to wake my mom up and let her know that we were leaving. He started putting our bags in the car. I changed clothes and put my shoes on in addition to a jacket in APRIL, thank you New Mexico. My mom came into the room and I was giving her some last minute information about Kate's schedule when a contraction hit. I breathed through it and started talking again and then suddenly there was another contraction. A really hard one.

"That didn't seem like three minutes," my mom said. No, it didn't. And on the 10 minute drive to the hospital I watched the clock on the dashboard and realized that suddenly, these things were coming about two minutes apart. Maybe less. And they hurt. A lot.

"I just hope I'm far enough along to get an epidural" I said to Dan. And I laughed. Again.

We parked our car in front of the hospital entrance and left it there, since it was 3 a.m. and it didn't seem it would be in anyone's way. Dan said he would come back and move it once I was settled in. On the way to the elevator we had to stop twice so I could hang on to Dan during contractions. Same thing as we walked through the doors of the labor and delivery floor and into the line of vision of Lola (not her real name), who turned out to be my labor and delivery nurse. Later, Lola would tell me that she had seen me coming, "With your pillow and your purse and I thought 'That girl isn't EVEN in labor.'" Oh, Lola. If you had only known.

But at the moment I am not noticing Lola because I am meeting the midwife on call for our practice. She has a resident with her, and the two of them ask me a few questions. We actually have a really nice chat and everything is very low key. I have a contraction and turn around to lean on Dan and breathe through it, which I apparently do with some measure of control because the midwives comment on how well I'm coping. They say they'd like to check to see how far along I am before the next contraction. So I get myself on that awful short, high little triage bed and the resident does an exam during which a kind of confused look comes over her face. Now I will later come to give this woman high, high marks for her bedside manner and presence of mind during what's about to start happening, but as a patient you don't want to see someone looking confused when they are examining you. I am thinking this when suddenly it's my turn to look confused.

"I'd say you're at seven centimeters," the resident announces. I laugh. She has to be wrong. I tell her she's wrong.

But she isn't wrong. The attending midwife confirms what she said. And suddenly the room takes on a very different tone. Lola the nurse appears to start an IV for a set of antibiotics I have to have because I'm Group B Strep positive. The attending midwife steps out to notify the charge nurse that we'll be needing a room immediately. When she gets back we talk a little about what my delivery with Kate was like and she and the resident take turns trying to estimate how big Isaac is, which is apparently a kind of game people who deliver babies play to amuse themselves. They both peg him around 7 pounds. I laugh. Seven pounds. I wish. No, I tell them, Kate weighed 8 pounds 8 ounces, and I don't have seven pound babies. We agree to disagree. The midwife asks me if I had been planning on a natural delivery.

"I was planning on an epidural," I tell her in my most polite "Woman, are you crazy?" voice. And I will give her credit for this -- she was honest. She said they'd start the necessary lab and paperwork for an epidural immediately.

"But all of that takes a little time, and it's possible that by the time we're set up, you'll be so far along that we'll have to forego the epidural. If it's any encouragement, you are progressing really quickly, and I think he will slide right out."

I think this might have concerned me a little more if at that moment Lola the Nurse had not distracted me by utterly failing to place the IV, poking me about six times in the process. I was not impressed, but perhaps in retrospect I should thank her for giving me something to focus on other than the thought that OH MY WORD we might be about to have a natural delivery. Still, Lola and I did not get off on the right foot what with that whole IV thing, and so I was even less inclined to be patient when she started asking me ninety-nine questions required for admission to the hospital.

Let's hit the pause button on this whole thing for a moment so I can tell you a hilarious true fact: I answered all those questions when I pre-registered for the hospital. I did this two weeks before Isaac's due date in the admissions office downstairs, in the middle of the day, during business hours. I did this specifically because, as I told the woman behind the desk who helped me with the paperwork, and I quote: "I sure don't want to answer all these picky little questions when I'm in labor." Then I laughed. "Ha ha!" I said. NEVER LAUGH, PEOPLE. If you learn anything from this story, that should be it. Because I answered most of those questions again while in labor, and everything was so chaotic that it wasn't until hours later that I remembered I should have just told them that I pre-flipping-registered.

At some point the midwife came back to say that a delivery room was ready for me. Here's another interesting fact: It turns out that those awful little triage beds have wheels on them, and I'm glad because at some point between walking into the hospital on my own power and going through the triage process, the contractions I was having had definitely gone up a notch or 12 in intensity and I am not sure I could have walked down the hall. They were coming so fast together there was almost no break in between. The next few minutes are a little hazy to me, and the next thing I remember is being in a real hospital bed and listening to Lola continuing to rattle off questions, which was just as annoying as it had been in triage. I did pretty well for "What is your social security number?" I held it together for "Have you received adequate prenatal care?" But when we got to "How much weight have you gained during this pregnancy?" right in the middle of a contraction, I totally lost it. "ARE YOU KIDDING ME? I DON'T KNOW!" is all I managed to get out. What I should have said was "Seriously, at this point, does it really matter how much weight I've gained? Enough to hurt you if I could get up off this bed, that's how much, lady!" But even though I was not at my most articulate, Lola somehow sensed that this would be a good time to cool it with the questions already. Yep. Nobody asked me aaaaaanymore questions.

It's a good thing too, because right then my water broke.

I think that was the exact moment when I knew we were about to have a baby the old fashioned way, sans drugs. I also knew that once my water broke, things were likely to get really intense, really fast. I'm glad I knew that, because it prepared me in a minimal sort of way for what happened next, which is that the next contraction I had was so unbelievably, body-rockingly strong that I discovered what would be my main coping mechanism for the admittedly short duration of the labor: Screaming. I have never made that kind of noise in my life. A few hours later when we were on the mother-baby floor filling out paperwork I realized that my voice was hoarse and my throat actually hurt from the screaming. In between contractions I would think how horrible this must sound for people down the hall from me and that I should apologize or try to hold it down or something, and then the next one would come and I would scream even louder. It was the only thing that helped.

I am pretty sure that from the time my water broke until the time Isaac was born was less than an hour. During that hour, our midwives were champions. Since it was apparent that I was not going to make it long enough to have an epidural, they jumped in and started coaching me, and coaching Dan on how to coach me, with breathing suggestions and ways to cope through each contraction. This made such a huge difference for me. I really started out hearing a voice in my head telling me that I could not do this. I mean, people train for natural childbirth. They take classes. They develop strategies. They learn self hypnosis. I hadn't done any of that! I wasn't qualified to have this baby this way! Who did I think I was? This was not a very helpful voice. And it made it that much more important for the midwives to keep talking to me, telling me that I could do it, that I was doing it, that I was strong. I was on my left side, holding on to the bed rail with one hand and breaking Dan's fingers with the other during contractions. The resident put pressure on my back which felt wonderful. And for the space of a few contractions, I got into this strangely remote place in my own mind. The pain was still terrible, but for some reason I could hear myself thinking really clearly. Given how crazy everything had felt to me just a few minutes before, it was surprising to suddenly have all this clarity. I'm not saying it was blissed-out enlightenment or anything I'd want to experience again, but it gave me a couple of minutes to stop freaking out and get my mind focused for what I now realized I was about to have to do -- get this baby out.

That little period of time felt like suspended animation to me, but it was really probably only a few minutes long because not that long after my water broke, I started feeling incredible pressure. Sure enough, I was 10 cm and it was time to push. I say "it was time to push" as if I made some voluntary decision to start doing that, but that's not really how it went. It was more like my body was throwing itself completely into the process of pushing, whether I wanted to help or not. It was totally involuntary. I have never experienced anything like it. When that started happening, I also got really unhappy with the position I was in on my side. I started to move to lie flat on my back and just couldn't do it. It felt terrible, like I would die if I had to stay in that position, but I couldn't think of what else to do.

In a lot of the birth stories I read, the phrase "listening to my body" came up a lot. And I rolled my eyes. But suddenly I was in this situation that I never intended to be in, and that phrase came to me. Actually one of the midwives said it to me. "Do whatever feels good to you. Listen to your body!" In a more self-possessed moment I might have said that what would feel good to me would be some DRUGS, but sarcasm seemed like a waste of breath at that point. So I turned around in the bed and rested my weight on my hands and knees, thinking I was just doing that in order to find some other position. Surprisingly it actually felt a lot better to stay that way. However it also momentarily made the contractions stop, and I completely panicked and started asking if this was OK, if I could be in this position. The midwives assured me that this was a perfect position to be in. They raised the head of the bed up so that I could lean on it, which was really helpful, and then the contractions started again.

Looking back, I know that I pushed for less than 15 minutes, which couldn't have been more than 10 contractions, and that at that moment I was so close to the end that it was all but over. Still, that part feels really long in my mind just because of what a psychological uphill battle it was to gear up to push each time, to push harder even though it made the pain worse, and to not get discouraged when I would feel the baby's head move down and then back up again. I knew that was normal, I had read about it, but oh my goodness it made me think he was never going to come out.

Now I would like to take a moment to acknowledge what an incredible trooper Dan was. We did NOT prepare for this, people. Our basic philosophy about baby birthing has not changed since Kate was born. That philosophy, in case you didn't read about it or have forgotten, is called "Heck no, we don't want to see the placenta." Or anything else for that matter. When I was thinking about trying to have a natural birth on purpose, Dan was supportive, but I think there was a certain sense of relief for him when I decided to just have the epidural. But when it became obvious that we were not going to be having the kind of birth we had planned, he was incredibly calm, and that helped me. He still parked himself up by my head and told the midwives he didn't want to see anything, but I appreciated his head-of-the-bed policy because I needed him up there with me, to keep telling me I could do it. It was actually really brave of him to sit right there. Believe me, it wasn't pretty. Lesser men would have run away.

So back to the end: After one particularly long contraction, the midwife told me that the baby was going to come out in one more push, she just knew it, and when he did they were going to hand him up to me, so to get ready to hold him. I sincerely thought she was lying to me, but if she was, it worked. I put everything I had into pushing when that next contraction came, and then he was out. Everyone cheered. I collapsed on the bed in total relief and exhaustion, and true to her word, the midwife handed the baby up to me immediately.

That's how we met our son. He was pink and perfect and so wide awake and alert, staring back at us with big eyes. The midwives were saying how pretty he was, and what a beautiful birth it was, but I could hardly hear them because I was shaking all over and my ears were ringing. Turns out all those women I laughed at while reading birth stories are right about the high of natural childbirth. I felt great. I felt like electricity was running through my body. I felt like I could fly. Mostly I just felt amazed that I had done it.

Our son was born right as the sun started rising over the mountains. He latched on and nursed for a half-hour while we looked at him and laughed with the midwives and said over and over again that we couldn't believe everything that had just happened. After a while, they weighed him, and when he came in at 8 pounds, 5 ounces, we laughed about that. See? No seven-pound babies for us! I had to rub it in since the midwives had been right about everything else. Lola went to the window and opened the blinds. Sunlight filled up the room, and I thought how nice it was of her to do that. Then she went to asking me more danged questions. Always with the questions. But I didn't mind so much this time.

What was the baby's name, she asked, poised to make his little hospital bracelet. His name is Isaac Daniel, we said.

And Isaac means "laughter."

Epilogue: Last week I went back to my midwife for my followup appointment. Mostly we talked. She wanted to hear the whole birth story, and was so pleased to hear how well everything went for us. I did not have the hemorrhaging I had with Kate, and I have just generally felt so much better so much more quickly after Isaac's birth that it has truly felt like a miracle. Again, we give the glory to God for answered prayers.

My midwife asked me if I would plan a natural delivery for our next child after having experienced it both ways. To which I said "What next child? I am never doing that again! We're done!" OK, not really. The truth is that I don't really know what I would plan for any future births. I don't consider myself a natural childbirth diehard, and if I were faced with a long, difficult labor again I might go for the drugs. My labor with Isaac was really only very painful for a few hours, and I have no idea how women endure that kind of pain with no end in sight. What I do know is that we will be choosing a midwife if we can. I cannot place a value on how big a difference the women who cared for us during the pregnancy and birth made for us. When I left my midwife's office last week, she hugged me. So did her nurse. These are people who really invested themselves in us, and I am profoundly grateful for that.

With Isaac's pregnancy and birth, I learned that things can be different a second time around. If any of the women reading this take one thing away from this story, I hope that is it. A difficult experience does not have to define childbirth for you. If you aren't happy with something, make a change. Every birth is different, and you have no control over that. What you can control are the choices you make. Read. Inform yourself. Don't settle for a caregiver who doesn't want to be a real partner with you or makes you feel like they don't have time for you. Whether you see a midwife or a doctor, find someone you can communicate with and who listens to you.

Lastly, if you're shooting for a natural birth, I give you this encouragement: If I can do it, anyone can do it.

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