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3.08.2013

A Serene Birth

Like most women, my birth journey started when I was young. My mom told us how she gave birth to each of us naturally. How when her water broke with me (her eldest), she asked my dad to get a towel, and in his 1am stupor he stumbled back to her with a tiny face cloth. She told me how she gave birth to me 6.5 hours later, and that seemed like a long time to me. I got my period at 11 years old and my mom hugged me and told me how proud she was of me. I thought – what did I do? Just got crippling cramps monthly and worried because someone at some point told me birth was 10 times worse. In health class at the age of 16, when everyone’s thinking about sex, I was the only kid in class absolutely fascinated with the birth video they showed us to scare us back into virginity for a little while longer. I knew that, even though I wanted desperately to be an astronaut and an architect, I also wanted to be a mom someday – I wanted so much to give birth. I wanted to bring life into this world with my body. I thought that was one of the coolest things I could ever do. And I never doubted I would do it.

Flash forward through boyfriends and college and graduating by the skin of my teeth. Unemployment and underemployment, humbling experiences God needed me to have to grow and mature and really pursue my career. All things to teach me that, no matter how hard you work at something or want something, sometimes things don’t immediately go your way. Time passed. That awesome job finally came my way. My last and best boyfriend became fiancĂ© and then husband. Debt got paid off slowly but surely. We took the big 3-week trip backpacking across Europe. We bought our first house.

And then it was time. Time to get on with the business of making a family. We were so excited and nervous that first time we didn’t use a condom. I had been off birth control for years. This was it!! He was a honeymoon baby and I was the result of my parents celebrating the construction of their first house, and I had spent the last 10 years trying NOT to get pregnant – so clearly we would be surrounded by our little gaggle of kiddos before we knew it. What a nice way to commemorate our 3rd wedding anniversary, by conceiving a child. And then... Time passed. No baby. Briefly, a light blue line... And then an early miscarriage. More months passed. I was convinced I was broken; he was convinced he had the problem. Finally, we took a month off from trying (and crying)... And of course that’s when we conceived our first child.

Pregnancy started out in a predictably miserable fashion – nausea all day every day for the first 14 weeks. But I reveled in the fact that it was “normal”, and I savored the nausea in this weird comforting way, because I knew that meant everything was OK. At 18 weeks we were delighted to discover we were having a girl – mind you, we would have been happy either way, it was just wonderful getting to know a little more about her. I read birth books and birth stories and we took a birth and childcare class at the hospital. My weight gain was spot-on, and the conclusion of my pregnancy was for all intents and purposes textbook – after a minor brush with pregnancy-induced carpal tunnel (just in time to write Christmas cards and 92 thank you notes from the heaps of blessings we received from friends and family), my due date arrived.

Imagine my surprise when the contractions started right on time, 40 weeks and 0 days. I labored at home like I was told to, waiting for the moment when my contractions would be close enough together to go to the hospital. Finally, after 24 hours, they were. The second 24 hours of labor were a blur of monitors and back pain, and my husband holding me up through it all (standing was the only comfortable position I could find). I was clinging desperately to the notion that I could have a natural childbirth, but wondering casually what was taking so long, and always fearing something was wrong. After that, the last 12 hours were the toughest. Pitocin was used to move things along, back labor got worse. My cervix was “complete” and I was told to lay back and push while holding my knees in the air, even though I didn’t feel the urge, and I knew lying flat was WRONG but I didn’t have the words to push back, or suggest something else. I don’t know how many times my best friends and husband counted to 10 while I pushed with every muscle in my being. 2 hours later we consented to an epidural and the OB turned my daughter in the hopes that a better position would allow me to push her out, but by then my contractions were dysfunctional and I was exhausted from not having eaten or slept in almost 2 days. Finally, we agreed to a c-section, and they wheeled me into the OR.

Labor had been so intense for so long that my daughter came out having trouble breathing, so I kissed her on the forehead and she was whisked off to the NICU. My husband went with her, and I was left with an anesthesiologist who wouldn’t look at me, and God knows what going on on the other side of the curtain. I couldn’t stop shaking. I felt so alone. I was running a low fever, probably from a uterine infection due to the length of labor, and wasn’t allowed into the NICU to see her for 2 days (53 hours to be exact). Pictures of me, without my baby, in my hospital room have me smiling with my bloodshot eyes from pushing so hard for so long. My husband brought me pictures of my daughter, and once, an audio recording of her crying. I fell to pieces when I heard it, but that was the only time I let myself cry. I busied myself receiving well-wishers, filling out paperwork, and figuring out how to get around with my new abdominal wound hindering me. I pumped and pumped to get my milk to come in.

Something shifted when we took her home, at 10 days old, and I guess I decided since I’d screwed up her birth, I sure as hell wasn’t going to screw up breastfeeding. Even though she was used to high-flow NICU bottles and refused to latch at first, we kept at it, and after a month we finally figured it out. Those first 3 months were this dazed delirious time period of sleep deprivation and bonding. I never really thought much about her birth I guess until I went back to work and had to start talking about it. I got through those casual conversations, but something about talking about it opened a dam I hadn’t realized was there. I don’t know, maybe it was all the well-meaning people saying “at least mom and baby are healthy, that’s all that matters.” That wasn’t all that mattered to me. I started talking about it at home, with my husband, with my best friends. I couldn’t talk about it without crying. I couldn’t think about it without crying. I had FAILED. My mother had pushed us all out without a problem. My sister had pushed out her son – and he had come out posterior facing!! What was wrong with me?!

It got worse. Other friends went on to give birth, and I got to the point where I couldn’t go to the hospital to visit them – the last time I went, I just stood in the doorway of her room, watched, detached, as everyone else went in and ogled over the baby and congratulated her, and I could barely keep myself from crying or screaming. I was just filled with this intense jealousy. The words echoed in my brain: SHE. DOES. NOT. KNOW. HOW. LUCKY. SHE. IS. She had pushed her baby out vaginally. I started hearing so many stories of people having vaginal births – people who had not read as much as me, people who had not wanted it as much as me, had even joked about having c-sections instead. IT. WAS. NOT. FAIR.

At some point in a moment of sheer horror at the amount of anger I had in me, realizing I was becoming someone very different from how I saw myself, I reached out to my best friend whose mother is a therapist elsewhere. Between the two of them, they said I might be exhibiting signs of PTSD, and they suggested I perhaps find a therapist locally. I spent 6 months working up the nerve to find one. After all, I’m smart! Why couldn’t I figure it out on my own? What’s wrong with me anyway that I couldn’t handle this? Plenty of women have c-sections every day, and they’re not falling apart. So what’s wrong with me?

Eventually I became angry at my job. I started lashing out at people for things completely unrelated to birth. This toxic reaction to this life experience was burying itself into my self-image. One day I finally said “enough”, and I called a therapist. She was immediately helpful, embarking on a campaign to get me to stop judging myself. That same month I found ICAN, a support group for women who’ve had c-sections. What a relief to learn I was not alone, that plenty of women have had c-sections and have HATED that experience, all the while loving the children those experiences had produced. I talked to my OB about wanting a VBAC for my next child’s birth, and subsequently fired her based on her unsupportive response. I discovered “doulas”, and added that to my list of ways to change my next birth experience, to make sure I had more “tools” in my “toolbox” to address all of the unexpected ways a birth can progress. I worked hard in therapy to confront all of my feelings of failure and inadequacy. I cried and cried, but this time the tears were productive, because I had stopped judging my feelings and learned to just allow myself to be disappointed. I read and read and read about VBACs, with the thought in my head that “I am not a toaster oven, you do not open me when the baby is done.” I learned to love birth again, to hope again. I attended the natural waterbirth of my friend’s second son, supplying her water and food and taking pictures. As soon as I held that baby, I knew it was time. Again. Time to get on with the business of expanding our family.

I interviewed 6 OB’s, and by the time I found the right one I was 5.5 weeks pregnant. He confirmed the pregnancy, and we were on our way again. Pregnancy was the same – same 14 weeks of nausea, same healthy weight gain, same textbook progression. But this baby was different, already exhibiting her own personality – instead of threatening to kick out my ribs like her older sister, she was so gentle – occasionally stretching, and many times gently running her hand down the inside of my belly. Every appointment my OB would take me back to his office after my exam and we would talk like colleagues, discussing my birth preferences but also discussing birth in general – in hospitals, in Houston, in America. Births he’d attended, birthing techniques I’d heard about. We talked enough birth philosophy that he wasn’t surprised or offended by my birth preferences sheet, and he happily included it in my record to go over to the hospital before my due date arrived.

We took another childbirth class – Hypnobabies – which is an intense training on how to use hypnosis for reducing pain and increasing relaxation during childbirth. We worked hard, and addressed emotional hang-ups while learning to work through physical tensions. I found every way possible to doubt whether I’d be able to give birth vaginally, and my support team never failed in propping me up, encouraging me, and reminding me how strong I can be. My husband never ever doubted I could give birth – he had seen my first daughter’s head through my cervix, and knew I’d come so close, and that I absolutely could do it if given another chance. His voice was joined by my best friends who listened to me talk about all things birth for years, who reflected all they’d learned from my babbling right back at me, right when I needed it. And joining that chorus was the voice of my doula, whose emails always struck the exact tone I needed at that moment – friendly, motherly, logical, cheerleader, shoulder to cry on, light-hearted subject-changer...

The Houston summer was scorching, and being a pregnant former-Yankee, I was far from comfortable. Everyone told me 2nd children come sooner than 1st children, but of course this little girl was so laid back, she could not be rushed. My due date came and went, and the holiday weekend approached... No baby. Her biophysical profiles and non-stress tests looked great each appointment... Until they didn’t. At 41 weeks 1 day I was diagnosed with “ogliohydramnios” - somehow, over the 3 day weekend, her bag of waters had gone from full to empty. No leaks, just disappeared. My OB told me she had to be delivered. For a moment I feared he meant via surgery, but he assured me he could give me a shot at birthing vaginally, but that we couldn’t waste time waiting for her to decide if today was her birthday – we had to give her a little push.

Induction. Crap, I thought. There goes my VBAC. Induction doubles a woman’s chances of having a c-section if she’s a first time mom, and since I never pushed out my first child you might as well lump me in that category. While the overall chance of a successful VBACs has been documented around 75%, he had already given me lower chances because I had had the opportunity to push, and my baby had been 7 lbs 2 oz, and I hadn’t been able to push her out. So in my mind induction just pushed my likelihood of success down even further. Still, I wanted to try.

and, as Dr. Milner says, "every woman wants a chance, and every woman deserves just that, a chance."


My husband was already with me; I called my doula and she came to the hospital right away. I made arrangements for my daughter to get picked up from school and cared for overnight. My OB broke my membranes (no rush of fluid), and ran an amnioinfusion so that baby girl would have some waters to play in and ease her way down the birth canal. I was happy – excited – nervous – just trying to keep my attitude up so my strength would last. My doula and my best friend rubbed my feet and legs, hitting acupressure points to jump start contractions.

things started a little bit, but your body definitely could use a little extra umph. So....

After a couple hours my husband and I kicked everyone out, and took a page from Ina May Gaskin’s book, encouraging love hormones to help things along – by the time folks came back, my contractions were regular, and about 7 minutes apart.

Magic, that love hormone is, yes?

It was time to get out of bed (catheter be damned) and do some work to move things along.

And move it along you did. Such a determined and focused, lovely and confident woman you were and are.

The nurses started a low level Pitocin drip to gently augment the contractions we’d started. I got on the birth ball and labored there for hours, taking breaks to get up and stretch whenever I could. My husband snuck me food. My friends joined in on the stealth-feeding. I let people take care of me, and didn’t worry about what they thought, or if they were bored.

I was so happy to see you giving yourself over to be loved and pampered. Your support team was right there at every beck and call, which freed you up to lose yourself to your birthing time.

The pit was stopped for a few hours while the nurses were understaffed and couldn’t dedicate someone to me (to watch for rupture, due to being an augmented VBACing momma). We talked and joked, and I took a nap... And then the pit got turned back on and things started to get serious, and I put on the iPod and listened to my Hypnobabies tracks and just breathed. I feel like that part went on forever, just breathing and drinking water and focusing.

Your determination showed on every pressure wave. You became intense, and intensely relaxed. Beauty in motion.

At some point I got back up in the bed – I don’t remember why – maybe for a cervical check?

Yes.

And I just stayed there. I had it propped up so I felt like I was almost sitting forward, and things were getting really tough. The contractions were a lot closer together and it was all I could do to relax.

you were definitely entering the start of transformation and "I don't know" was your refrain to every suggestion. In the end, you chose not to move from the upright position, but you still were able to remain on top of every pressure wave, so I was happy to give you some rest time.

Baby needed to descend a little bit more, so my doula recommended the Walcher’s Trochanter Roll technique, and we did that for a little bit.

I asked you to promise me just 3 pressure waves. I have to tell you, the funny looks we received from the nurses when they walked in on that position were enough to make me giggle. Thankfully, they jumped right in to help and actually took my copy of Midwifery Today to the nurses' station to read up on the position.

After one pressure wave, you told me you didn't like the position. After the second you said, 'only one more?'. And, after the third, you nearly jumped out of that position... but it had done it's job!

Then I sat back up, and with my husband on one side of me and my doula on the other, I entered transition. I knew it was transition because I started doubting whether I could do it, whether I could complete this journey.

From my vantage point, you were moving quickly to the birthing time. You would greet every pressure wave with a deep breath and a 'zoning out'.

Every contraction brought a moan from somewhere deep inside of me, and my breathing tightened. I panicked. I was so afraid of the pain and yet part of me knew it was almost over. Panic became nausea, and I threw up. I absolutely hate throwing up and generally avoid it with every fiber in my being, but some part of my brain remembered that it would help me open my cervix the rest of the way, so I went ahead and let it happen.

The contractions continued, and I clung to the stereo chorus of my husband and my doula, telling me to release each time, to breathe, to focus.

One half of my brain screamed “I WANT AN EPIDURAL”; the other half screamed “TOO BAD IT’S TOO LATE, YOU’RE ALMOST THERE”.

You would then intermittently shake your head 'no' and I believe I even heard you mutter 'uh uh' once. I knew there was an emotional and mental battle going on, and I was eager to see who would win... the mother you truly knew you were or the mother who was holding on to that last thread of doubt that you were nearly done.

I closed my eyes and kept them closed as I became the typical transitioning momma, crying out about how it hurts (and then apologizing for complaining), moaning through each breath, lifting up off my bottom as the pressure increased.

At some point during this time I mentioned relaxing your bottom and allowing baby to move down and you gave me a look that said you were none to happy with your doulas suggestion at that time, but you did it. You did it and I saw your determination to overcome the counter-intuitive nature and welcome these last few pressure waves as they brought you to completeness.

Suddenly the pain was just too much, I had to DO. SOMETHING. ANYTHING. So I tried pushing. Not because I felt the (physical) urge to push, but because I felt the (emotional) urge to DO. SOMETHING. I just couldn’t sit still and “endure” them any longer. The nurses called my OB and he verified I was complete, but then I heard him say “I think you gals jumped the gun – this lady pushed for 4 hours last time before needing surgery – I think it’s still going to be a while, call me when she’s really pushing” and then he patted my leg and LEFT!!

Dr. Milner has a way of lightheartedly egging a woman on.. He smiled with a mischievous glint in his eye as he turned to leave. You can tell he was trying to push you to that place where you were done with laboring.

I’m told he only got as far as the nurse’s station. Because at that moment something BROKE in my brain and I said to myself “F-CK NO, I’M NOT DOING THIS ANOTHER 4 HOURS!” I flipped onto all 4’s (IV and leads be damned) and gave it all I had. Immediately baby started turtle-heading out. +3 station, 0 station, +3 station, 0 station. My OB came back in and said “looks like we’re getting serious” and then boy did things start happening!

They sure did!

I kept hearing the door open and close, and I peeked once and saw like 15 people in my room. My husband told me afterwards that none of the other mommies in L&D were pushing at that time, and my doula told me that several of the nurses just wanted to see the VBACing mommy. I’m sure they wanted to see my OB work too – he carries a lot of clout at that hospital, and has been practicing for 40 years. I heard (but did not see) his “tool kit” being deployed on the table next to my bed – he is very proficient in the use of several types of forceps, taught by the best back when they bothered to teach OB’s about assisted deliveries (instead of c-sections). I assumed a “sitting squat” (bed back raised so I could sit up, legs up on supports putting my knees by my chest without needing to hold them there), and I got really quiet – I just wanted to focus on pushing, because then I was feeling the physical urge to push (finally!) on top of the emotional need to DO SOMETHING. My doula and my husband reminded me over and over again with each contraction to release my arms, release my legs (both of which were kind of pushing on their own), and just focus all my pushing power to my bottom. After less than half an hour (I’m told), I started to feel the burning sensation in my perineum and I knew she was close.

 I pushed with each contraction and I pushed between contractions whenever I could. Then my OB said “there’s the head – stop pushing a minute” and I remembered to pant like all the stories I’d read while he checked her neck for cord wraps. Then I pushed firmly but gently and she wiggled her shoulders out and then there she was on my belly. Which is when I finally opened my eyes and gazed at my second beautiful little baby girl.

Unbelievable.

That was the word I kept saying over and over. Unbelievable. It didn’t end in surgery, despite how it started, despite all my misgivings about my pelvis size and my ability to give birth. I just couldn’t believe she was here, and that she’d arrived through my own power. My husband kept saying “it’s such a miracle”. My doula couldn’t stop smiling.

And the rest is history. Baby girl was insanely healthy at birth, 7 lbs even, 19.5” long. She nursed right away, and hasn’t stopped since. Her latch was perfect from the start. We roomed in, and went home TOGETHER 2 days after she was born. Her big sister loved her from the start, and the vaginal birth allowed me to be a better momma for her, rather than having to focus on protecting a healing incision from an overly affectionate toddler. My self-image has sky-rocketed – I’m back to knowing I am a strong, hopeful woman.

But, more importantly, I am THANKFUL – thankful for being blessed with the opportunity to try for the birth of my dreams, thankful for my birth team without whom I would have struggled mightily, thankful for the luck of a baby whose position was better (possibly just by the luck of a differently-placed placenta), thankful for all of my friends who supported me and listened to me and encouraged me through all of those months of anger and frustration and doubt and hope. Thankful for this unbelievable birth and this beautiful baby girl.
Thank you, T, for sharing your story! You did such an awesome work!

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