January 6, 2011

A Labor and Delivery Nurse's Homebirth

Let me start this by informing any readers that I am a labor & delivery nurse, and am currently in my last few months of a nurse-midwifery graduate degree program. So I might get a little technical, and my perspective was a little different than the average first-time mom who has no idea what to expect. Granted, though I had an idea what to expect, I still had no idea how labor or birth would feel, how long it would last, etc etc. So I was still clueless in the most important ways! We planned a homebirth and saw exclusively a homebirth midwife. I decided when I was 18 that I was going to become a Certified Nurse-Midwife, and I knew that I would plan homebirths for my babies. Reading stories about homebirth midwives is what inspired me to become one, so it was definitely my plan long before I even became pregnant or my husband and I were even engaged. He knew from the get-go that it would be happenin' at home! (PS - if anyone is interested in discussing the research supporting the safety of homebirth feel free to contact me through CGB, I'd be happy to connect you with articles, etc!)

Prelude: I had difficulty falling asleep the night of Monday, March 29th following our appointment with our midwives, when they had discovered that my baby was still in the "sunny-side up" position, aka the dreaded "OP" (occiput-posterior) with his face facing my belly button rather than my back. This means the widest part of his head presents to the cervix and these babies, unless they rotate spontaneously in labor (or with assistance!), are very difficult (though not impossible!) to birth vaginally.

When I finally fell asleep, we were very rudely awakened at 2:25 am by the grating blare of our apartment building’s fire alarm. Of all things, and all days! We stumbled out of bed and down the stairs (against Toby’s protests and requests to ‘just stay in bed’), and waited in the pouring rain with the other tenants while the fire trucks lined up outside. After ten minutes of searching the fire fighters came back out. Evidently the building was not engulfed in flames, and we were allowed to go back to bed.

Because I was still so upset about the idea of birthing an OP baby, I lay awake until about 5 or 6 am worrying about the possibilities of birthing an OP baby. And cried some more.

I finally dozed off around 5 or 6, only to waken around 8 am with a series of what felt like rather intense gas pains and a serious case of the runs. I felt my belly harden with each pain as I raced to the bathroom, and had the inkling that these might be the start of labor. But I was mostly in denial, and really felt that the nature of them was probably just some GI thing or another, and to wait it out—they’d surely pass just like the rhythmic Braxton Hicks that were coming off and on the past week or so. But then, I noticed they kept coming…about every 10 minutes. And quickly, they become uncomfortable enough that I was running to the bathroom every few minutes to empty the rest of my colon—and though I felt all day like my bowels couldn’t possibly contain anything more, I managed to have diarrhea up until about two hours before Elijah was born. The strangest part was that they really felt like food poisoning, but more intense, and my belly became rock hard with each wave. I began to get nauseous with each one. They still were about 10-15 minutes apart, so I firmly told Toby when he awoke that he could NOT call the midwives—it was way too early! We finally agreed that at 1 pm, if they were still coming, he could call to at least let them know I might be in early labor. And I made the decision that I could definitely not go out anywhere today, so he had to call off our plans with some friends who were in town visiting from NYC—informing them that I was in labor. I kept telling him not to tell anybody, since this was our first baby and labor could last days or just fizzle completely and I didn’t want to cause any false alarms! He almost went out with the friends by himself at my insistence, since the contractions were about 10-15 minutes apart and bearable at the time he called them. But he decided to stick around, and wisely!

Nancy (our midwife) ordered me to get some rest since she said I was likely to have the baby late that night or early the next morning (I thought she was being awfully optimistic, especially since I hadn’t even had any bloody show—just lots of nausea and diarrhea, and I’d so far vomited once). Wonderfully, Elijah and God granted me an hour or so of beautifully spaced-out contractions so that I slept deeply in between each, between about 1 and 2 pm. We agreed to check in with Nancy around 5:30 pm or 6.

Around 5:30, Toby called Nancy back to tell her I was still having contractions, a bit closer together, and asked for any recommendations for comfort measures. By this point I was on the floor with each contraction. The pain was breathtaking and unrelenting—it felt like a million saws grating against my sacrum. He was definitely still OP, because all of my labor felt like absolute agony in my lower back. His skull grinded relentlessly against my backbone with each contraction and I literally just focused on surviving each one. It felt somewhat better to make low toned howls with each wave, which I began doing in earnest, especially once I jumped into the shower at Nancy’s suggestion. The water against my back felt good enough that I remained in there for about an hour, during which the contractions picked up in frequency significantly, coming about every 3-5 minutes (we were no longer timing them, but I could just tell). Toby had called to ask that perhaps Nancy send one of her student midwives to offer some support, telling her we didn’t think we were ready for her to come yet. Danielle & Tammy would be on their way in a moment, she said.

Danielle arrived shortly thereafter and offered some comfort measures that I tried but immediately declined because I could not handle any counter pressure on my back—it just felt that it dug further into the searing bone pain with each wave. I did get into polar bear position which offered some relief, especially between contractions. About 15 minutes after Danielle got here, Nancy called back to check in and heard me mooing in the background (probably asking for the Lord to help me, which is what I was shouting at this point from the shower with each wave), and told Toby “I’m getting in the car!”. I still felt it was too early at this point, that this could still fizzle, that it would last all night, and I didn’t know how I’d do it. I decided if she checked me and I was 1-2 cm, I was going to refuse to last any longer. The intensity of the back pain was too much for me—I’d made it about 10 hours at this point and was feeling nauseas, had vomited several times, was terribly thirsty from all the diarrhea and vomiting, but unable to keep anything down, and I was becoming truly weary. I dreaded each contraction and just focused on living through it, bellowing curses that I’m sure terrified the neighbors and those walking down the street past our window.

Soon, Heather, Nancy’s partner midwife, arrived and offered me some relief with rubs and affectionate pats. Her touch felt amazing, and her confidence in how well I was doing made me feel marginally better. I just remember moaning to Tammy, “Why is our baby OP? I just hope I’m not 1 cm—I haven’t even had any blood show!” And her quiet responses: “So that when you’re a midwife, you understand!” and “That’s okay!” (about the lack of bloody show).

Nancy arrived, and what a godsend. She walked in, came right to me and put a cool compress on the back of my neck. She began to talk me through each wave, looking me in the eye and holding my focus, asking me to relax deeply, to find the depths of my capacity to birth even through the pain, to tell myself that I was safe, that I was a mama lion. I managed to hold on with her through a few contractions wherein I felt like my body was being ripped apart from my sacral bones, and asked her to check me to see if she could possibly change the position of the baby.

Imagine my surprise when she laughed joyfully and exclaimed that she almost didn’t believe her fingers, because I was nearly fully dilated and my water would break any second because my bag was bulging hugely.

And break it did, in a huge splash that coated almost our entire bedroom (thank goodness I had had Toby make the bed over with the plastic fitted sheet by that point, and Nancy had hastily removed the quilts at some point after she got there and before my water broke). All I remember is the feeling of the gush, hearing the splash, and the peals of everyone’s laughter at the mess from the fluid. The room was giddy. Everyone but me—I was still in agonizing back pain with each new wave, but suddenly my body began to bear down intently with each contraction. I started to push, more by instinct than actual purposeful action. My whole body was just seized with powerful urges to push, before I even really recognized that was what I was doing. Nancy told me if the pushing felt satisfying, the cervix was likely completely gone and she didn’t need to check me again. It did feel satisfying, and also took away some of the back pain.

I switched to my back because my hands and knees were exhausted, and they helped me hold up my legs in lithotomy position—oddly enough, as this was sort of the opposite of the way I’d envisioned giving birth at home. But the relief of complete rest in between pushing was wonderful, and finally, at some point in the pushes, my back pain disappeared completely and was replaced by the burning of tissue as his head came closer and closer to being born.

It felt like forever, but was only actually about 35-45 minutes of total pushing efforts. Eventually they told me to reach down and feel the top of his head—it was wild! I almost couldn’t tell the difference between my tissue and his, except his just felt like a little ball of harder skin. It was insane. Then I began to really want to meet him, to feel the power of the fact that in mere minutes I was going to actually meet this baby we had loved for 40 weeks and 3 days, and made love to make, and who was part me and part the love of my life. I was impatient! Not to mention, it became incredibly uncomfortable. When I felt the ‘ring of fire’ (which was NOTHING compared to the pain of back labor), I decided I’d risk tearing and that I officially wanted to get this baby into the world ASAP. Once his head was remaining on the perineum between pushes, I gave one or two huge, mighty pushes and he came flying into the world—no crowning time; he jumped right out in one fell swoop, head, shoulders and body. The down side to this was a relatively large tear that required probably 6 stitches. The up side was the incredible relief of having him on my chest and absolutely no labor left! I have never experienced such utter relief at having something over. And he was so incredibly alert! A nice lusty cry and completely pink—he got Apgars of 10 and 10, and let me tell you, I have never once seen that in the hospital. But he deserved them! I didn’t even see any real acrocyanosis in those first few minutes! Elijah Erson was finally here, 7 lbs exactly, at 9:13 pm (A mere 2 hours after the midwives arrived!)

It was the biggest rush of my life. I just remember feeling in complete awe, and asking Toby to tell me whether he was a boy or girl (since I was lying flat, it was a little difficult with trying to keep his dry blankets over us for me to look for myself). Toby made the announcement and I remember saying “Elijah—and he was born on Passover!”. When we decided on Elijah, I had read that the name was often given to (Jewish) baby boys born around Passover. As I had read that statement from a naming web site, I remember feeling that this baby might be born around Passover; in any case, my ‘due date’ was near Passover, so it seemed like a good possibility. As it turns out, he was literally born the night we were supposed to attend a seder with friends.

The midwives were incredible. Nancy stitched me up, they made tea, cleaned the apartment of the birth mess, took my vital signs, weighed the baby and did his newborn exam, gave us lots of love and affection, sat me up with lots of blankets and helped me nurse, and kissed us goodnight. And then it was just us—by 11 pm, the team was gone and it was just our new family looking at each other in awe. Shortly thereafter my parents arrived with my brother in tow—I had asked specifically for my parents to bring him with them (he was a college student living across the city from us at the time Elijah was born) and we had a champagne toast and shared in our joy and excitement. Everyone was astonished it was over so soon!

editors note: Here are a couple of links to articles regarding homebirth.




Jackie said...

Great birth story. I can totally relate to most of it. I had two OP babies one 8 lbs and one 9 lbs. I agree the crowning is nothing compared to long endured bone breaking pain of back labor. I had a long early labor both times. I think the hardest thing about the OP position for me was that the first time around I planned a completley natural birth at a birth center with midwives, but I don't think I realized that I could possibly be in such incredible pain for so long without being close to actually birthing the baby. As a result I completely exhausted, dehydrated, and over whelmed myself. I did not rest between contractions, drink enough, eat, or keep the whole thing in perspective. I labored for a long long time before succumbing to pain meds. However, I do think I could have done it if I had handled the early part better. I did birth vaginally in the end of a long labor and that was great. I did need a rest and respite from the pain though for a couple hours and did end up at the hospital. I was so glad I did not have a C-section. The second time around I assumed I would have a OP baby again and told myself I would rest and drink and eat. I did soooo much better the second time because I had experience. I gave birth at a birth center with all the same terrible pain, but only 15 minutes of pushing (2 hrs first time), no tearing and I felt like superwoman. I have never felt so strong or proud. We went home four hours later. It was amazing. I guess since you are a midwife I think it is important to let first time mothers know that even though a person may be in early labor the pain may be almost as intense as active labor although the contractions might not be as frequent. I started early labor at 2 am on a Tuesday and did not have the baby until Wednesday at 5 pm. I found that experience confusing and anxiety provoking the first time around, but the second time I just accepted it and new it was normal and "my way" to go through labor. I knew the first time could be long, that you should eat, rest, drink, but again I was taken aback by the intense pain when I was not in active labor. Thanks for your story. It was a great example of how we can endure so much physical pain in labor, but come out on the other end with immediate relief and exhilaration. Good luck with your future in midwifery and motherhood.

CGB story said...

My two births were completely different. It is hard to anticipate how your birth will go. I do believe that being supported by trusting and loving people is most important and to trust in yourself and your body.