Peace to Progress

My husband's family had introduced me to the idea of home birth, but having assisted my Certified Nurse Midwife in the hospital, I chose the comfort of knowing my provider over the comfort of my own home. Still, I was thankful for the time I spent at home. Driving away from my massage, I felt the first "real" contraction. Though it was still late morning, I promptly settled myself down for a nap. Staying at home as long as possible helps both your body "rest up" before true labor and "open up" to allow progression. I waited until my contractions were about 3 to 4 minutes apart and more difficult to manage before waking my husband just after midnight.

I had spent the last few hours at home on a birth ball. Not really knowing much aside from "they're good to use during labor," I did what came naturally...bounce. If you don't remember anything else from reading this, please remember: NEVER BOUNCE ON A BIRTH BALL IN LABOR (birth balls can be incredibly helpful for positioning, but bouncing rushes the baby's progression--often wedging them at a less than ideal point in their natural rotation). I felt a strange shift in Marielle's head placement that made each contraction hurt more. I wrongly assumed this was a good sign in a "no pain, no gain" simplicity. Looking back, I can now recall it vividly as an "unnatural pain" indicating a less than ideal fetal position.

Positioning in labor can make all the difference between "failure to progress" and the natural delivery of your child. After arriving at the hospital around 2 am, I was checked and admitted at 6 cm dilated. Five hours of hall walking, showering, and ignorant ball use later, I was in excruciating pain and seemingly stalled at 6 cm. My midwife (Kathleen Philbin, CNM - Select Women's Healthcare) arrived on the floor around 6:30 am and quickly deduced that Marielle was stuck in a posterior head presentation. She suggested a couple of positioning maneuvers. To my great relief, I felt my daughter's head shift again within just an hour or two of her adjustments. This time the sharpness of the pain lessened subtly while the intensity began to double. This was my first full-submersion lesson in the language of labor pain. Listening to the quality, intensity, and location of a woman's pain can often give insight into helping her reach delivery smoothly.

I progressed quickly from 6 cm to 10 cm and was ready to start pushing around 10 am. Knowing that transition can produce some crazy outbursts, I had two goals: (1) Not to say the phrase "you did this to me" to my husband, Daniel, and (2) Not to physically harm him. With this in mind, I knew that eating during labor and waiting until you can't keep from pushing help to reserve energy for when it's needed most. Unfortunately, halfway through one of my more intense pushes I found my hand uncontrollably digging its nails into Daniel's arm. Horrified, I tried saying sorry between pushes, but the next contraction hit with my hand touching his head. The sentiment came out as, "I'm so sorREEEEEE," with a fist full of his wavy hair hopelessly entangled in my fingers. At least staying rested and nourished though labor helped me keep from saying anything I regretted too much!

With my husband on one side, mother on the other, and trusted midwife ready to receive my daughter, I did find myself saying a phrase I had heard others say so many times before: "I can't do this anymore!!!" Simultaneously, I could hear the nurse in my head chiming this tried and true reassurance, "Yes, you can! Your body IS doing it. Just let it happen." With that moment came a flood of understanding and appreciation. Having someone you trust supporting you through your delivery is the best way to avoid potentially necessary interventions. Moments later I held my little girl in my arms for the first time. Simply put, there is not way of expressing the depth of love that surged in that instant.

Despite the nearly idyllic delivery of my daughter, Marielle's birth brings mixed emotions. The day after her birth (and the ten days that followed) served to shape my practice as a labor support person even more than the labor and delivery itself. Due to a medical error, our Marielle contracted an infection and required IV antibiotics. Through the roller coaster of unexpected choices and emotions surrounding our NICU experience, I discovered that a birth story does not end at delivery. Continuity of care that supports you from pregnancy, through birth, and into the weeks that follow is essential for families to feel they have received the best care possible. Despite all that, Marielle fought through and is now a beautiful 4 year old with soft blonde hair and a tenacity for life! More than anything, her birth left me certain that I wanted to see my clients through not only their delivery, but all the struggles along the way and thereafter.

My Second Birth:

Micah Elias, my handsome little introvert, came into this world just months after we uprooted from Florida and planted ourselves on the outskirts of Columbus, OH. With so little time to get established and financially drained from the move, we scrambled to find a provider to assist with the delivery. After landing in NICU with Marielle, we wanted to avoid the anxiety of a hospital delivery. Home would provide the best environment for me to relax. So our search focused on home birth midwives. After interviewing a few, we settled on a young pair of midwives that attended births together. While they were inexperienced, we liked the fact that there would be more than one set of hands assisting at delivery. I had chosen comfort with my provider over the comforts of home with my first birth. Now that I was so far from the provider I knew and trusted, choosing the comfort of a home birth seemed that much more essential and I am grateful to have had Micah at home.

My mom flew in a day or two before my due date. As soon as she arrived I could feel a shift in my body as it readied for labor. While the timing of labor is far from predictable, feeling you have the support you need often helps your body relax enough for the process to begin. Because our only bathroom was on the main floor, we christened the dinning room as our birthing suite and prepared all the necessities for our first home birth.

While my body was ready, Micah just wasn't quite where he needed to be. So I would have a few contractions, then none at all. I would think that things were starting, but back to sleep I'd fall. This was my second full-submersion lesson in the language of labor pain. The frequency, duration, and intensity of a woman's contractions not only help to chart the progress of the labor, but also hint at how the baby is positioned. Still an ignorant birth ball bouncer, nothing I was doing helped his positioning. After two days of uncommitted contractions, eventually my body decided to make it happen anyway.

Going into day three, I decided to just rest as much as I could and focus on distracting myself. While movement during labor is very important, a successful experience requires finding the balance between keeping rested and changing your position. Even with all I knew about labor, I was surprised by how different this seemed from my first delivery. Daniel and I got to spend a lot of quality time together and this really helped to keep my mind off of feeling out of control. Oxytocin released in the brain from simply being around those you love is another great tool for helping a women's labor flourish.

Finally, around 2 p.m. I started feeling the contractions gradually intensify. They were still 20 minutes apart, but lasting longer than I expected. We carried on with more movement and rest until our midwife called around 6 p.m. By then the contractions were still 15 minutes apart, though more intense and lasting up to a minute and a half. Little did I know that my cervix was already 8cm dilated and by the time both midwives arrived to "check in on me" I was nearly 10 cm. Contractions do not need to be 2-4 minutes apart for "real" progress to be made. This was an especially surprising discovery for me coming from the hospital mentality that would have suggested pitocin to "augment" a labor like this.

The contractions continued in that pattern until delivery--getting 7-8 minutes apart at their closest. I began to feel the urge to push, but it was accompanied by a sharp stabbing pain every time I attempted it. Normal pain associated with pushing has a much more burning/stretching quality. I kept telling the midwives that something wasn't right and finally after some convincing they found I had a cervical lip--a swollen area on the cervix that does not stretch to accommodate the baby's head. This served to further build my labor language dictionary: Pain Described as "Stabbing": [oüCH] indicative of pushing on a cervical lip.

With a small amount of position changes, the swelling was resolved and pushing came naturally. Yet something still didn't feel right. Though I had gone through my pregnancy reassuring myself that second deliveries were "easier," I quickly found this delivery out rating my first on the pain scale. This was where my midwives inexperience showed itself. As I pushed into the pain, having to visually throw aside my expectations for Micah's birth, suddenly my water burst. Simultaneously, both midwives faces went white. All they could see were ten little fingers as my son's hands were both over his head. Every birth challenges you to not only throw aside your own expectations, but also the expectations of others. On seeing their faces change, I knew their concerns were for a dystocia--a dangerous situation where the infant's shoulders wedge them in the birth canal.

I thank God for the determination I had at that moment to get Micah through at any cost. Baring down as hard as I could, he was born within two pushes. The total relief of holding him on my chest after that extraneous labor leaves me lost for words. More than anything, that moment filled me with a certainty that our bodies are able to birth our babies--no matter their position. Since then, I've further learned to admire the rhythm my body chose for bringing Micah out. The contractions--both stronger and longer than usual--served to push him through despite his unusual position. Likewise, the longer rest in between contractions served to allow him the recovery time he needed.

Looking back, the final lesson Micah's birth seared into my mind is that dehydration equals hemorrhage. With lots of uterine massage, iron support, and nursing we were able to quickly get it under control. I question whether any of that would have been necessary had I been better supported. I consider it paramount to encouraged all of my clients to eat and drink throughout their labor and I know first hand the benefits that hydration and nutrition provide.

My Third Birth: