9/11/2008

Carolyn's Birth

This is going to be a long post. If you're not interested, don't read it.

A few have asked about Carolyn's actual birth, so I thought I'd share. No gory details, I promise. :-)

Our official due date was August 22, so at our appointments on the 18th and 25th the midwife started telling us about our options. In order to remain in the low-risk category and be able to give birth at the birth center instead of the hospital, you have to be between 37 and 42 weeks gestation. While we weren't enthused about the prospect of any induction methods--including herbal or other more natural ones--we were less enthused about the prospect of a hospital birth, where there are more restrictions on movement, eating, time spent laboring, and recovery stay as well as a higher incidence of C-section, medical intervention, and infection.

We didn't want to know specifics of dilation or effacement measurements, as they are not clear indicators of when labor will begin and we preferred not to get unnecessarily excited or impatient. The midwives made their recommendations with that in mind, and we didn't ask for more information than we felt we needed to make an educated decision. So, with 1 day to go before our official due date, I started taking supplements of Evening Primrose Oil, which is supposed to help soften the cervix to aid dilation and the start of labor. By our first post-40-week appointment, 4 days later, the midwife said the oil was no longer needed. She scheduled a precautionary ultrasound and non-stress test for Thursday the 28th. (The ultrasound was a fluid check. Amniotic fluid levels also have to be between certain measurements for a birth-center birth. The non-stress test involves wearing a fetal monitor around the belly for 20 minutes to record the baby's heartrate and the mother's contractions.)

On Thursday, the non-stress test was fine. The ultrasound tech estimated Carolyn's weight at 9 pounds, 11 ounces and also said we had a good deal of extra fluid. The midwife laughed--literally. I just wasn't that big, either by appearance or measurement. Ultrasound estimates are standardly 10-15% off anyway, so we weren't worried. Still, to cover all the bases, the midwife scheduled a second ultrasound and non-stress test with a prenatal specialist for the following Tuesday (September 2nd). If his results were the same, she said we would pay more attention. She also performed an exam on Thursday, and we found out after the birth that I was dilated to a 4. Also, we discovered via the ultrasound that Carolyn was still turned posterior--facing my front instead of my spine, which causes the more intense and painful "back labor."

We got a prescription for an herbal labor tincture that induces contractions and went to a compounding pharmacy to pick it up, but we opted not to use it until at least Saturday (which is why the tincture is still sitting on my bathroom shelf, unopened), giving my body as much time as we felt we safely could to progress by itself and still ensure our ability to give birth at the center.

During the day on Friday, I had a fair number of contractions, but nothing painful or more intense than I'd been having sporadically for a week or two. I stayed busy, cleaning and filling Carolyn's dressers that were just moved into her room on Thursday and finishing up some other preparations for my parents' arrival Saturday. By the time Kevin got home and we had dinner--somewhere between 6 and 7pm--I started having more intense contractions. They continued sporadically through the evening, usually about 20 seconds long and somewhere between 2 and 10 minutes apart. We decided to go to bed, not wanting to stay up all night for nothing and then be already tired when contractions began to come more regularly.

Unfortunately, lying down was extremely painful. I didn't feel the back labor so much while I was up sitting on the birth ball, but as soon as I got in bed to sleep it was intensely painful. I could handle it, but not sleep through it--so we got back up and prepared for a night of labor. Kevin slept sporadically on the futon in Carolyn's room, where we'd settled in for the benefit of the extra padding provided by the carpet--I found the best way to withstand the back pain, which got progressively worse, was on my hands and knees, or on my knees leaning over the birth ball. Also, the hands and knees position is supposed to help a posterior baby turn over, so I was diligently trying to help Carolyn help me. I can tell you that 12 hours on your hands and knees is not a lot of fun, and my muscles were exhausted by the time everything was finished.

The contractions themselves were not that severe, but the pain that focused in my back was. I slept about 15 minutes twice, both times interrupted by 2 or 3 contractions, which remained 2-4 minutes apart and 30-40 seconds long all night. By morning, I was exhausted and my back hurt badly. I had eaten a little through the night, but the back pain also took away my appetite and I was getting shaky from low blood sugar. We called the midwife on duty (Megan) about 8:30am, and told her where we were. I knew Carolyn hadn't turned and I was starting to wonder about my ability to endure many more hours. Megan suggested we try an inversion--putting my knees about 18 inches higher than my elbows, my body in a head-downward, diagonal position--for about 20 minutes, giving Carolyn a chance to disengage and have more freedom to turn over. She said we were welcome to come on in to the birth center, but it would be fine to stay at home until contractions were regularly nearly 60 seconds long and 5 minutes apart.

So, at 9 am, I had my knees on the futon and my elbows on a stack of pillows on the floor. Twenty minutes and too many very painful contractions later (I really don't recommend laboring upside-down unless you have to), I returned to hands and knees on the floor to facilitate turning, should Carolyn have shifted enough to do so. Within the next couple of hours, it was evident that the inversion worked. Although contractions continued, my back pain slowly subsided and then disappeared. The contractions then got more intense and regular, but were infinitely less difficult than the entire first 12 hours had been.

I got an hour or two of sleep through the day, waking up every 6 minutes or so but sleeping soundly in-between. My parents arrived around 3pm; Jen kindly brought them from the airport and then brought us all dinner later, and by 7pm--24 hours of labor behind us--I had been having firmly established, 50-second contractions every 4-5 minutes for 2 hours. We called Megan again. Though we didn't know I had been dilated some on Thursday, she did, and we met her at the birth center for a progress-check rather than settle in for another night of labor at home without knowing how close we might be.

I still didn't want to know any dilation measurements, so we just asked her to check and advise us if we should go back home or stay there. She did the exam, looked at us, and said she wouldn't tell us what it was. . .but it was a big number. We weren't going anywhere.

Kevin unloaded our clothes and snacks (at the birth center, mothers are encouraged to continue eating and drinking high-calorie items to keep up the strength and energy needed for labor and birth). We continued the same as we had been at home, me changing positions as often as desired and Kevin helping however I asked him to. I didn't spend any time on the bed, except every 3 hours or so when Megan performed an exam. Wherever I was, Megan or the attending nurse (Kimbre, for most of the night) checked the baby's heartrate every 20 minutes or so, then every 5 minutes after the membrane ruptured, and it remained strong and steady throughout.

By 1am, when my water still hadn't broken, Megan suggested a couple new positions to help the cervix finish dilating. We tried that for over an hour, without visible results, and Megan suggested that she break my water. Because I did have a good amount of fluid and was a week past my expected due date, they were concerned that perhaps there was too much cushion for the baby to break through. Also, she wanted to make sure there was not meconium already in the fluid.

I knew that I was getting tired and we needed to move things along, but I really wanted to wait for things to progress on their own. We asked for another 15 or 20 minutes to continue contractions in one of the new positions. Megan easily agreed--the midwives at the birth center all along made us feel like we were completely in charge of what happened or didn't happen. They advised as to what course of action they would like to take, but never once made me feel like it wasn't completely up to us.

I was praying that my water would just break on its own, but after another 15 minutes, I reluctantly relented and asked Kimbre to tell Megan she could come and artificially rupture my membrane. While she was gone, I moved toward the bed so I would be ready, but had to pause for a contraction--and then my water broke, suddenly and loudly. Megan and Kimbre heard it down the hall.

By now, it's 3 am. Commence pushing contractions.

Pushing was long and hard. I was exhausted from 48 hours with less than 3 hours sleep, and my muscles were jelly from the 12 hours on my hands and knees, followed by 20 in various other positions. I still didn't lay in bed, because natural birth advocates advise that a prone position is the one least likely to encourage a baby to come out. At one point, near the end, I thought to myself, "This is ridiculous. How did women ever do this without drugs???" And, a moment later, "Wait. I don't have any drugs!!!" I would have laughed, but I was busy.

By the time Carolyn actually came out--at 6:45--I was so shaky that it took Kevin, Megan, and Kimbre to support me so I could push. But we were successful, and little Carolyn emerged with no medical help or medication in her tiny system. She weighed 8 pounds, 6 ounces and was 21 inches long; and she was clamoring to breastfeed within 2 minutes of birth, before the cord was even cut. When she finished her first meal and nap, she was as rosy and bright-eyed and alert as she ever has been, as you've no doubt seen from her Birth-Day pictures.

After the birth, Kevin prepared a hot breakfast in the birth center kitchen, and we both ate, showered, and napped before heading home with our new arrival about 1 o'clock.

So. . .would I do it again? Absolutely. While I realize circumstances differ and childbirth decisions are intensely personal, Carolyn's eager alertness from the very first moment has completely affirmed my confidence in natural birth. I am so thankful that we were able to forgo any sort of induction or medical intervention and so thankful that we chose to wait patiently when action could be justified. I am thankful for the midwives whose experience and expertise supported and guided us without pressure or insistence. We sought from the beginning to trust God in the timing and delivery of this baby, and He has proven faithful in so many ways.

1 comment:

Sassi said...

Wow...you are my hero. All three of you did a fantastic jo! I am very proud of you for being strong and staying in control. I do not want to even attemp to do what you did but I think you set an amazing example of how strong women can be if they just try. I hope however that your next child isn't as stubborn to come out :).

Sophie misses you by the way. I have been showing her pictures of her godparents and telling her all about Carolyn.