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Beautiful, Tired, and Drained....Oh My... The Story

Michelle and Ryan –

Oh what a journey! You have displayed immense strength in the face of adversity, and come out together, as a birth warrior and birth companion! I cannot begin to tell you what an honor it was working with the two of you as you fought for your baby’s and your body’s rights and health.

You prepared for birth by attending a Wonderfully Made childbirth class. There, you learned how to cope with labor, talk with your care provider, the pros and cons of medications and interventions, and how to be an educated consumer. Near the end of your 6 week series, you asked me the question I was hoping you would, “Will you be our doula”.

Your due date was May 2nd. It came and went uneventfully. You patiently waited on your bodies timing. On May 11^th, you went to a prenatal appointment where they performed an NST. The nurse pointed out that you were having contractions rather regularly; they were so gentle, though, you hadn’t even noticed.

The next morning, May 12^th, around 2am, I was awoken by a phone call that they were getting more intense. By 4am, I was on my way to your home… your contractions were 5 minutes apart and beginning to demand your attention. After working well with your contractions at home, including squatting, taking a shower, doing some nipple stimulation, walking the neighborhood, and taking a short nap, we talked a bit about comfort of moving to the hospital versus staying home.

Your emotional indicators said that you were in early labor. Your physical indicators were saying you were in late active first stage. The behavior of your body and contractions led me to believe that your baby was still not lined up correctly in your pelvis. We worked on positioning some more, but nothing changed. Ryan was fine staying home and ‘playing guitar’, while Michelle was more inclined to want to stop by the hospital to see about your progress.

We talked about trying to pick things up in intensity with cohosh, stopping at your doctor’s office rather than the hospital to avoid being ‘admitted’, what would most likely occur if we went to the hospital, and the benefits of just staying home. After talking about all of your options, the benefits and risks, and trying to call the doctor’s office to be seen there and not receiving a response, you decided it was time to go to the hospital.

At the hospital, they found you to be 4cm and 75% effaced. Contractions were varying between 3-5 minutes standing up or sitting up and 7-10 minutes while lying down. They deemed that you were ‘in labor’ and considered you ‘checked in’. We had discussed that, if you were not 6cm or more, you wanted to go home, but the pressure between hospital staff and yourselves mounted, so you consented to staying.

By the time they had you checking into your room, though, your contractions had spaced out to around 15 minutes apart and they were very faint. We talked awhile about your options. You were prepared to request an AMA and check yourselves out, but then you had a nurse change. She was sympathetic to you wanting to leave, so she performed a vaginal exam and deemed you ‘only 3’, and made the request to your doctor to send you home.

Michelle, you were very frustrated, but Ryan mentioned something that awed me and put things into perspective… You had not consented to anything that you could not walk away from. You did not consent to pitocin or breaking your water, two things that they had urged you to do and would have put you at the point of no turning back.

You continued to have mild, but regular, contractions throughout Wednesday and Thursday. During those days, we continued to try positions to move baby into a better presentation. Your doctor had scheduled an induction for you on Friday morning at 7am. In your heart, though, you did not feel ready to relinquish your pregnancy to the doctor’s schedule and asked the doctor to give some time to prepare and think about it more.

At this point, Dr. Oldfield made some very threatening comments and attempted to manipulate and coerce you into the induction – even stating she was going to drop you if you did not show up in 1 hour. You were not persuaded.

Friday and Saturday brought you regular contractions about 5-7 minutes apart, off and on, a little stronger, but no more demanding. On Sunday night, you came to my home for a Ribozo sifting, At that time, we also talked about options… including midwives, homebirths, making amends with Dr. Oldfield, switching hospitals, switching doctors, and rights of the patient. Your main concern, and I agreed, is that you were ‘overdue’ and were without prenatal care under any doctor at that time. No doctor would take you at 42+ weeks, and your doctor’s office was not returning calls or releasing records to you.

You outlined a plan to find out who was on-call the following morning at your hospital, Baptist, and decided that, in the a.m., you would consent to an induction.

Monday morning, May 19^th, we arrived around 9:30am and began the paperwork to being admitted. A small power struggle ensued, where you had to remind them of your rights to request a different doctor (based on ethical disagreements) and you were given Dr. Richards, the hospital’s ER OB, as your primary during your stay.

Dr. Richards was very accommodating to leave a relatively open schedule for your birthing time. You requested pitocin rather than an Amniotomy, which they had wanted to perform. At 11am, Michelle was started on Pitocin, so Ryan and I grabbed a quick lunch. You were assigned an amazing nurse who was a great advocate of unmedicated birth. The three of you formed a wonderful team.

Contractions soon picked up, even on a low-dose pitocin drip, and you began to have to work through them around 1pm. You sat on the birthing ball, received a foot massage and hand massage by Ryan and I, squatted beside the bed, slow danced with Ryan, and knelt on all fours over the birthing ball.

I encouraged you both to cuddle and nap if you could, and I went into the waiting room to let you both reconnect and rest.

Contractions became very intense after dinner time, and Michelle continued to move with her labor, getting into every possible position that would accommodate the continuous fetal monitoring.

Baby was slowly turning into a better position, which I could tell by the demand of the contractions on you mentally and emotionally, while your wonderful nurse could tell by the position of your uterus to your cervix, the position of your cervix itself, and the presenting part over your cervix.

Around 9pm, you requested your water to be broken in hopes to kick things into high gear.

You both were beginning to show some of the wear that the last week had had on you. Michelle, you were physically exhausted and the pitocin was giving you strong contractions. Ryan, you were emotionally and physically fatigued, though you were a constant support to Michelle. Michelle, you began to get the shakes, becoming nauseous, and questioning your ability to continue.

You were checked and found to be 7cm around this time. Michelle requested an epidural around 10pm. You were adamant. Ryan and I talked with you about the benefits and risks, and I truly believed that you were getting ready to transition. Your nurse felt the same and encouraged you to continue on. Baby was still moving well, getting into position.

Your nurse’s shift, though, was ending. Her replacement was the same nurse we had seen 1 week prior and who had helped you to be able to go home. Though Ryan and I worked at making sure that you were making an informed decision to the benefits and risks of the epidural, she, surprisingly, gave false information on the epidural and encouraged you to get it.

Also, on examination, she said you were between 5-6cm. Dr. Richards came in to get your verbal confirmation that you wanted the epidural and did a vaginal. She did not tell us what she thought you were.

After making sure there were ‘no regrets’, you received your epidural at 11:30pm. Within 15 minutes of receiving it, your blood pressure dropped, babies heart rate was lost, and you were put on oxygen. They stopped your pitocin and, though it hadn’t been increased in over 2 hours, the nurse who had encouraged you to get the epidural and given you false information on it stated that the baby was not tolerating the pitocin well.

Dr. Richards had the internal fetal monitor ready to insert, when another nurse finally found babies heart rate. It was found in the same position he had been early in your labor, low and posterior. It was at a higher baseline than before, even without the pitocin, and non-reactive to the contractions. But he was strong and you were stable. Knowing that they were going to leave the pitocin off for a few hours, I encouraged you both to get some rest and I headed home for a few winks myself.

At 2:00am, I received a text that they had checked you and found you to be 8cm. I headed back to the hospital. At arrival, Ryan informed me that Michelle only had a small lip left before you were complete and could start pushing.

Around 3am, you began pushing. Baby descended quickly, and his heart rate stayed constant. Your blood pressure remained even. Baby descended straight down the birth canal, though, and his forehead met with the pubic bone directly. He was not turning his head in order to fit down the birth canal.

We talked about continuing to push as you were or your alternatives, including turning off the epidural so that you could get into more accommodating positions to try to turn him back into the more favorable position he had been in earlier in your labor.

After pushing for 2 ½ hours, you consented to turning off the epidural and we worked on getting you into different positions, including attempting the Gaskin Maneuver, all-fours, modified knee chest, side-lying, and modified squat. He was not budging. Your perineum was swelling considerably, though, and babe had developed a caput.

Around 6:30am, you began to request the epidural be turned back on. At that point, your doctor said that baby was healthy and you were healthy – she was willing to let you continue as you were, doing what we were doing to try to move baby, as long as babies heart rate was stable, although you might want to start talking about the possibility of a cesarean as things were not progressing.

Her veiled statement was that an epidural could very well be a step backward – it would make it unable for you to get in the positions that we would need to be able to have you in to even have a hope of moving baby down, and it might mean another ‘crash’ like what had happened the first time.

I talked to you about the possibilities: a new ‘dose’ of epidural could have the above affects, and would definitely not allow baby to budge for the limits in positions, we could continue without the epidural and hope to turn baby (although he had not budged with our attempts these first 3 ½ hours), or you both could talk with Dr. Richards about a cesarean.

You both talked about it, we spoke about risks and benefits, pros and cons of all options, and made sure that, regardless of your decision, that there was to be no regrets. You opted for a cesarean. While they prepped Michelle on the process and Ryan dressed in his scrubs, I talked to Ryan about how he could best support you in the OR. And then, when they were ready to wheel you out, I took our bags down to the family waiting room and talked to Ryan’s mom.

On Tuesday, May 20^th, 2008, some time after 7am, Elijah was born into the world after his parents made a very harrowing and difficult journey into parenthood.

I can already tell that he has the stubbornness shown by his mama because of his intent to stay in as long as possible. But more than that, he has the strength and fortitude that his parent’s have displayed in that he is a strong and healthy babe, with a good appetite and hero’s heart!

Congratulations Michelle and Ryan! I was honored to attend you both during this amazing transformation. You are parents, and you are conquerors! The path that was chosen for you gave you many opportunities to take alternative routes, some better than others, and you navigated this journey with a strong compass of what you were willing to accept and that which you weren't. Those things that you were not willing to accept were simply not an option - and nothing that anyone could tell you would make a you change that compasses due North. I have never met a couple more compelled to accept ONLY true informed consent, and accept both the benefits AND risks so wholeheartedly... taking every step as a deliberate act of 'no regret'. On the same note, 7 hours postpartum, I visited you again and one of the first things out of both of your mouths was that you HAD no regrets, but you already know what you WILL do differently next time.

Again, I am SO honored!

Le Premier Cri

An experience both unique and universal

Prequel... Just to Whet Your Appetite

As a prequel to the hopefully-soon-to-be-posted birth story from Beautiful, Tired, and Drained... Oh My, I am sending my readers to THIS birthstory.

B-B-B-Baby...

And, received a call last night at 9pm from my apprentice - she had just walked in the door from her first birth! Congrats Lindsay! Congrats Mama, Papa, and Babe! I loved the birth story, feel free to post me a link when/if you get the story up (and have mom's permission to share online). YAY!

Beautiful, Tired, and Drained - Oh My!

Well, a mama that I had been working with for quite awhile had her baby yesterday around 7:00 a.m. This couple is remarkable and amazing.

I have not talked with them about sharing the intimate details of their birth story, so I will have to get back to you on that. I did want to share with you all this wonderful bit:

They were due on May 2nd. They went in for 'labor' on May 12... They subsequently requested to be sent home after 14 hours of good labor that petered out and left them at 4cm. They then refused a 'mandated' induction on the 16th, not feeling emotionally or physically ready for it. And, after being dropped by their doctor, took matters into their own hands and had a very empowering birth that started on May 19th (10am) and ended on May 20th (around 7am).

They have me and many women in this community in awe at the strength of their character and determination not to be bullied by policy without medical justification. They are amazing! I am honored to have attended them!

Beyond that, I am tired for THAT reason, as well as having taught a Weekend of Relaxation Workshop on the 17th and 18th... so much time lately away from the family brood and papa bear that I am thinking I need some time with them. I will be on later. Adios!

Ahhh, Baby - Updated

After blogging Ahhh, Baby, I received a comment on it from the star of the movie. Here is her birthstory to accompany that video, in her own words:

"I am Amy Blake Rollogas and I am a childbirth educator. My training is with ALACE. ALACE is the Association of Labor Assistants and Childbirth Educators. They are a wonderful organization, and I chose to train with them because of their woman-centered approach to birth.

I wanted to give you a little bit of background on my own reasons for pursuing this certification. For those of you who know me well, or who are loyal readers of Wits End (all 2 of you!) some of this may be redundant. Feel free to skip the birth story if this is your 17th time reading it!

I am a nursing school dropout. I went to nursing school after a lifetime (read: childhood) of saying that is what I wanted to do. I didn't like it from the start. It was not a good fit for me. While I sometimes think I should have stuck it out long enough to finish, I have never wished I was a nurse!

While I was in nursing school, I had a wonderful OB clinical instructor. She was a Certified Nurse Midwife named Jessica Jordan. She opened my "medical" mind to how beautiful birth could (and should) be. It would be several years before I would birth my own daughter, but my thinking about pregnancy and birth had already been changed.

I began seeing Nadene Brunk, CNM for all my well woman care. When Brandon and I conceived in February of 2006, I continued seeing her for my prenatal care. We had a wonderful pregnancy. It was enhanced by the relationship we developed with Nadene. She supported me in my decision to pursue an unmedicated, low-intervention pregnancy and birth.

Brandon and I took natural childbirth classes with Chris Prescott. This class was wonderful. Chris did a fabulous job of helping us prepare physically and mentally for birth. I became convinced that good quality childbirth education is key to a positive birth experience. Brandon got even more out of our class than I did! As a voracious reader, there wasn't much factual information about birth I hadn't already read about. Brandon, on the other hand, got most of his info from this class. A well-prepared husband was a great asset during labor!

Toward the end of my pregnancy my blood pressure was a bit high. I was having it checked twice a week with a great desire to avoid being induced. Nadene was a great support as I approached 41 weeks pregnant. Every day past my November 1st "due date" was mentally grueling. I knew that the due date was just an estimate, but it had been the psychological "end" of my pregnancy.

Monday, November 6, 2006
After 3 weeks of sitting around the house waiting for baby, having tons of contractions every day and trying to keep my blood pressure down, I had gone 4 days past my due date. Brandon and I stayed home from church on Sunday because I thought that if I heard even one remark like, “You haven’t had that baby yet?” I might have an emotional breakdown.

Monday morning, one of the pastors from our church, Jim, called to check on me. He had been checking on us every few days, and had noticed that we weren’t in church. After talking with him for a few minutes, I had him assured that I was feeling great (I was!) and that we figured we would be waiting still a bit longer for our new little arrival. I hung up the phone and stood to let the dogs in the back door. Fortunately I was wearing sweatpants (very absorbent) because when I stood, my water broke! The elastic in the ankles of the sweatpants saved our brand new carpet from disaster! It was 9:30am.

Filled with butterflies of anticipation, I called Brandon to tell him to come home from work. He didn’t answer, so I left him a message. I still wasn’t having any “real” contractions, so I relayed that to his answering machine and got in the shower.

Once in the shower it was no time before I began having “real” contractions. They started in the front and wrapped around to my back. They were immediately more uncomfortable than the pre-labor I had been having for 3 weeks. I tried to be conscious of the energy of each contraction and rest in the knowledge that they were what was opening my cervix and bringing my baby to me. I had a great time in the shower! I prayed for a safe birth, sang to the baby and told it how I couldn’t wait to meet it, and fantasized a little about what the day would bring!

Brandon came home, and we set about getting our stuff together and readying the house for our friend Rebecca who would be coming to take care of the dogs for us. We made some phone calls and assured everyone that we would let them know when we had any news. During all of this I had to pause every 7 minutes or so to concentrate on my current contraction. They were becoming a bit more difficult to cope with and I was unable to continue any productive activity during them.

At 11:50am I called Shirley, my doula, to update her on our progress. I let her know that Brandon and I were enjoying laboring alone together for now and that we would like to be alone for a little while longer. I agreed to check back in with her in a little while to let her know when to come to the house. When I got off the phone, Brandon and I discussed how we would decide when to tell her to come. Nadene, my midwife, told me that morning to come to the hospital when my contractions were 5 minutes apart for an hour. I guess we figured we would call Shirley sometime during that “hour”. We called her, instead, around 12:05 when we realized that in the last 30 minutes I had gone from having contractions that were 7 minutes apart to 3 minutes apart and they were lasting 1 ½ to 2 minutes each. I never had 5 minute apart contractions.

By the time Shirley arrived, I was unable to talk through the contractions. If I happened to be standing during the “break” in between contractions, the onset of the next one would drive me to my knees.

I vomited a couple of times (surprisingly, it felt great), and the dogs became very attentive to me. I was vocalizing uncontrollably; kind-of a low-pitched moan. I coped well by getting louder and louder! I felt so powerful!

We continued to labor in my living room for about 30 minutes when I heard Shirley tell Brandon “If she does this a couple more times we need to go!” I didn’t really comprehend what she was saying, though. All I could think was “where did my break go?” Shirley and I were noticing the same thing… My contractions were now 2 minutes apart and lasting 2 minutes each! Literally, I took one breath after the contraction and the next one would start. Brandon told me later that I went through all of the Bradley Method “emotional signposts” in 20 minutes.

The next thing I remember was Shirley telling me to stand up and hug her. She would support me while we made our way to the car (only about 30 feet). Fortunately I got a few contractions with about a 30 second break in between, so it only took 2 to get me to the car! I prayed hard that I wouldn’t have any contractions in the car. Praise the Lord, I only had one on the 1 ½ mile trip to the hospital.

When we got out of the car, I promptly had a contraction and vomited in the ER parking lot (in a small wastebasket I had brought with me). Looking back, I have to laugh at the show I must have put on for the folks in the ER waiting room. While waiting for someone to take me up to L&D, I had several very LOUD contractions. When we first walked into the waiting room, I was hit with a particularly “good” one. Shirley and Brandon were just far enough away that I couldn’t reach anyone to lean on, so I hit my knees and held on to a chair while I moaned loudly. When the contraction was done, I looked up to find a wheelchair and about 10 hospital staff-members standing around me. Apparently they were afraid I was going to birth the baby in the waiting room. Boy, the inhibitions you lose during labor!!

It took us a while to get up to L&D as I refused to sit in the wheelchair. The nurse led us up to the 3rd floor wheeling the empty chair and patiently waiting for me through each of my contractions. When we got to our room, I vomited. I spent a few minutes laboring on the floor.

The nurses, per hospital policy, had to get a 15 minute “strip” of the baby’s heartbeat, so I had to get into the bed for a little while. Because I had been vomiting, Nadene decided to give me some IV fluids. She promised she would run them in fast and unhook me. By the time they were done getting the baby’s heart rate on record, the IV was unhooked. In the meantime, Nadene checked me. I was 6 cm dilated, fully effaced, and the baby was at 0 station!

I had requested a room with a tub for pain management. When we arrived, though, there wasn’t one available. Nadene told me that they were cleaning one, and we could move as soon as it was ready. I wanted to be in hot water, though, so we decided I could wait out the cleaning staff in the shower. She said she was going to go see a couple of patients and would come check on me in about an hour. Once I reached 8 cm, she wouldn’t leave until after the baby was born.

I got into the shower; once again I was on my knees. The hot water felt amazing on my back! At one point I could feel the baby’s head turning in my pelvis. I heard my voice yelling “Stop!” It hurt, but I couldn’t express anything. All I could do was tell it to stop! I had another contraction and told Shirley that I needed to poop. She told me to go ahead because we were in the shower and it would just wash away. My next contraction, I was pushing! I couldn’t control the urge. The nurses called Nadene back to my room and helped me to the bed. I guess they didn’t want me to have the baby in the shower. I asked Brandon later how long I was in the shower. He said 10 minutes max! I went from 6 cm dilated to pushing in about 15 minutes!

I have heard that in a drug-free birth, you will prefer either contractions or pushing. I did

not prefer pushing. After I felt the “ring of fire”, I was ready to quit. I think I actually experienced a 10 on the pain scale. I had always thought that was reserved for ripping off an arm, or something. Fortunately, when I got to the bed and really started pushing, the baby was already crowning. The nurse got a mirror so I could see the head. It was good to take a peek, but there was no way I could watch myself give birth, so I had her take it away.

I pushed a few times half-heartedly. The nurse was having a very hard time finding the baby’s heartbeat. When she did, we realized the baby was having heart rate decelerations in the 80’s when I pushed and the heart rate was not going back up between contractions. Nadene made eye contact with me and told me I had to stop playing around and push the baby out NOW. So I pushed. Hard. I thought it felt better and better the harder I pushed. Nadene cut a small episiotomy, and the next thing I knew, the head was out. I pushed again and our baby was born. She came out with her hand by her face and the umbilical cord wrapped around her neck and her body. It was 2:51 pm. Less than 5 ½ hours from the time my water broke.

Brandon announced to me that we had given birth to a baby girl, and Nadene handed her to me.

We held her uninterrupted for more than an hour. The baby nurse then took her only five feet away to weigh, measure, and bathe her. She was 8 pounds 8 ½ ounces and 21 inches long. We named her Eden Blythe.

I could not have had a more wonderful, beautiful birth experience if I had written it myself. It was such a supernatural experience. Brandon said and did all of the right things at the right times. He was a wonderful coach and partner (and he still managed to take some fabulous photos!) My doula, Shirley, was great, as well. She really empowered me to trust my body during a very powerful event. My midwife, Nadene, just let me do my own thing and labor. She was exactly how I envisioned a midwife should be. When the situation became a bit more urgent, she was matter of fact and told me exactly what I had to do.

I praise the Lord for the miracle of life and for the way He allowed me to bring this new little one into the world. God is so good!"

To read more from Amy, visit her blog here. Thanks, Amy, for the heads up!