Birth: naturally at home

On Saturday, Mom was in a lot of discomfort. It felt like gas pain; pretty constant throughout the morning and afternoon. Dad went to run some errands—Home Depot, compost drop-off, food coop shop—and Mom was so distracted that it took her almost the whole time he was gone to come up with the grocery list. Mom and Dad did succeed in organizing our electronics bin that afternoon, though. In the evening, we walked slowly to dinner at Screamers Pizza with our friend Eric. Mom was feeling pretty good then—and ate everything—but by the time we got home, she had petered out and had to basically watch (instead of help) Dad organize all the baby clothes we had gotten from friends and put them away in your room.

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Homebirth: A Partner’s Perspective

I walked over to the drugstore around 10pm to get a hot water bottle for Lori because her lower back hurt.  She’d been having contractions here and there throughout the day but nothing regular, Shar had told us over the phone to try and get a good night’s sleep and we’d see what was up in the morning.  When I walked back in the apartment I heard Lori pounding on the wall, according to the system we’d put in place — so she could alert me without speaking when a contraction began.  I went in the bedroom and I knew it was on.  My mind became very flustered and I’m sorry to say that I never really emerged from that state.

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Homebirth: A Positive Transfer Story

Our game plan from before I even got pregnant was to have a homebirth. It’s what I had always dreamed of, Patrick was on board, and we found an incredible team of providers that we felt safe with and supported by. Then two weeks ago, at 41 weeks, I had a standard biophysical profile to check on how the stubborn babe was doing and we found out that my amniotic fluid levels were super low and we really had no choice but to go to the hospital and get induced. I spent about twenty minutes feeling upset and frazzled by this major change of plans but after a few deep breaths and some phone calls to the right people I really truly felt at peace with what was happening and also begrudgingly amused at this one final pregnancy reminder that I was not able to control what was going on. Patrick, my sister Emma, and I hopped in a cab and headed tonto Woodhull Hospital where we spent a thrilling 7 hours in triage cause a bunch of babies had just been born, I peed in a cup and then nobody ever took it and I’m still laughing at that, and one of my midwives swung by to say hi and see how I was coping. Around midnight we finally made it into our own room and I started my first of five  doses of cytotec (which helps ripen the ol cervix and get contractions going). The next twelve hours were pretty boring, I was definitely having contractions but my pain level was like mild period cramps and my cervix didn’t budge a bit. Eventually Patrick went home to take a quick shower and Emma and I had a singalong dance party to the entirety of Hamilton. I was certain that this would dance the baby down and open me up BUT IT DID NOT. Things started getting a lot more intense and yet my body still would not budge, around hour 19 on the cytotec I asked about an epidural because my back and hips were in so much pain but the hospital midwives said they try to hold off on that until “active labor” and since I still wasn’t dilated at all it seemed a bit early so instead I called my amazing doula who showed up in ten minutes and worked absolute magic that allowed to me totally zen out for a few hours.

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Raising Funds and Raising Awareness

Congratulations to all who took part in this year’s Miles for Midwives Fun Run and Birth Fair. And thank you to all our generous sponsors! Not only were we the highest fundraiser, but our team member, Laura Coogan, won first place in the women’s division! The event raised $34,000.00. It was a beautiful day to bring awareness to the importance of midwives and to raise funds for scholarships and public awareness campaigns.

Face Presentation

Kneeling in awe of the unfolding birth before me, I quickly realize that I am in unfamiliar territory. I see swollen tissue that perhaps is a urethra emerging or that ambiguous vaginal tissue that presents before the vertex. Another contraction and clearly, it’s the baby’s lips. Soon the eyes emerge and in between, barely perceptible is his nose. The mother asks, “what is that?” And I can emphatically tell her it’s her baby’s face presenting first.

Face presentation happens in approximately 1 out of every 600-800 births, often this can be a longer labor and/or a longer second stage, if there is progression.

This was a quick labor, seven hours in total. I joined this birthing family in transition, barely having time to listen to the fetal heart rate before she felt like pushing. As she was standing and swaying her hips she said, “I hope you’re not going to make me stop moving.” This child was in a hurry.

Typically, during labor, a baby’s head becomes flexed, chin to chest, with the crown presenting first as it is the least significant diameter. By comparison, the fetal face presents a larger cephalic diameter that needs to negotiate the pelvis. Here is where pelvic shape can play a significant role in the passage of a baby.

Factors that could influence a baby’s presentation include genetic disorders, multiple nuchal cords, pelvic shape, multiparity, or black race. Or there may be no identifiable reason.

Babies who make this journey will have significant swelling and bruising of the face and molding of their heads as seen in this photo. During their journey out, their heart rate might show signs of stress, with slowing heard during contractions and pushing. This child’s heart rate was strong throughout.

IMG_1271The stars were in alignment for this baby, fast labor, ample pelvis, and a 10-minute second stage. I am in awe of women and their journey’s through labor and honored to have been in attendance at this particular birth.

Reflections of a Fledgling Midwife

This summer as a midwifery fellow with Shar and Carol has been remarkable. I feel so privileged to have become part of the family that is MCNYC, to have shared in the excitement and joy of expecting families and to have been present as they welcomed their new babes.

I have been immersed in the “birth world” for 5 years now, as a labor and delivery nurse and midwifery student, but this summer gave me a new degree of respect and appreciation for the birthing process and the strength and power of women. It also showed me that there is another, more humane and family-oriented way to care for women and their pregnancies at a time when I was disheartened by the many limitations of hospital-based practices.

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Shar and Carol support and nurture the families they care for in a way that I had never before seen from a provider. They gave me that same degree of support as a fledgling midwife—generously teaching me the ins and outs of running a business, the skills of careful palpation, basics of herbal remedies, and how to hold space for laboring women in a place that is theirs rather than ours. I will be forever grateful to them for this experience.I am also so thankful to the families who opened their homes to me and let me be part of their experiences. I learned so much from each of them.

And here is what I will remember most: a four-year-old girl waking up in the middle of the night to find her mother moaning deeply in the pool in their living room, and then, sleepy-eyed, pulling up her little chair to the edge of the pool and resting her head in her arms, watching her mother, turning to me now and again, smiling in wonder at her mother’s strength. 

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Solomon’s Birth Story

Solomon’s Birth Story:

The short version of my son’s birth story goes something like this: Before he was born, I knew that labor was so intense that I wouldn’t be able to make a sentence through it. So when I couldn’t talk anymore, that would be THE sign that I was in labor, the time to call for assistance, marinate in laborland and whatnot.  After he was born, I was pretty stunned to realize that I had become a parent without any of that.

Let’s just say that Solomon’s birth simply wasn’t what I was expecting.

Since my brother and I were born early, at 36 weeks, I went into pregnancy nervous that I would deliver around then. I got our apartment pretty much ready by 35 weeks, but I really wanted to birth at home and couldn’t do that until 37 weeks. As much as I knew that my labor would be mine rather than my mom’s, her experience was the closest benchmark I’d got. I had no idea to what extent my labor would be all my own.

Once I got past the 37-week mark and into homebirthing territory, I was relieved. I was doubly-relieved when I finished up enough at work to transition day-to-day responsibilities to my interim at 39+4. I was grateful that my company helped me keep some projects active so that I didn’t need to start my leave before becoming a parent.

Of course, my oft-stated perspective was that “while the average for a first-time parent was 40+5, no one is average.” Other loudmouth opinions in that sphere also included: “Guys, this is a uterine condition, not a liver condition. Stop telling me that I can’t have a drink” and “Look, in America we’ve got this trope that childbirth is the most painful thing ever. But it’s all a cultural expectation. In the Netherlands, only 35% of women experience pain in childbirth.”

At 40+3 my husband and I had our last regularly scheduled midwifery appointment and started talking about how to bring on labor just in case the child didn’t emerge in the coming week. For the first time, I started considering what would happen if the delivery went in the other direction –if the baby was too big for my loins or emerged too late for a homebirth. I made an appointment for an ultrasound at 41 weeks. And then, that evening after yoga, I had increased discharge and some leakage. I was excited. I thought “It’s finally starting!” We made an appointment for the next morning to confirm that my water had broken.

The morning of 40+4 we checked my pH and were disappointed to learn that my water had not actually broken. Shar mentioned that everyone’s labor pattern is different. For example, that it was possible to start with contractions five minutes apart. And we went about our days. My husband and I worked from home. I went to acupuncture for the fifth time that week. My dad was in town visiting for the day and so we met up for a beer. Around 5pm at the brewery I felt uncomfortable and needed to walk around. I excused myself and went to the bathroom. My dad was the family member who “just wanted to know” when labor was starting. But was this labor starting? I had no idea. I didn’t want to get anyone unnecessarily excited. And I certainly didn’t want anyone “just checking in” after two days in labor. Dad knew that the plan was to share the news once the baby was out. In hindsight, that was definitely a contraction.

Our doulas had counseled us to “distract yourselves for as long as possible if you think labor is starting. Only engage with it when you can’t ignore it.” So that we would save up our energy for when we needed it. When we got home, we made mac’n’cheese and set to watching Shakespeare in Love. I started feeling crampy every 5-10 minutes for a bit –so we started timing. These started coming every 5 minutes and lasted about a minute. I thought “Wow, I’m so suggestible. This is exactly what Shar said could happen.”

Halfway into the movie, the contractions were still coming and I was distracted. We figured it probably WAS labor. This was 9pm. We went upstairs and called Shar. We talked through a contraction. I found that doing the cat-cow yoga posture on hands and knees helped, so would drop to the floor and shift around. I wasn’t comfortable, but I could think and talk clearly. We made a plan to call back when my water had broken. We called our doula Yael and made the plan to call back when the contractions got longer and stronger or when I was uncomfortable enough to want assistance. I felt like taking a bath. I thought I might be more comfortable there. The bath was great, but my contractions shortened to 30 seconds long and did not intensify. It seemed like labor was stalling.

In childbirth education class, we had learned that the one sign of labor that EVERYONE goes through is a pattern of quickening contractions of lengthening duration and increasing intensity. We were watching for this and we were disconcerted that I had short waves where I felt crampy and then didn’t. We thought, “Oh man. This could take days.”

My husband and I weren’t sure what role would be helpful for him to play, and we WERE sure that it would be helpful later if he could be more well-rested than I was, so he went to sleep.

I skimmed the copy of the birth plan that I’d printed out a month prior. There were a set of mantras that I had intended to use. A story from Ina May’s Guide to Childbirth kept coming back to me –that of a woman who was confident that she was going to open huge and did. But somehow, “I’m going to get huge” wasn’t working for me in the moment.

I talked to my primate self, affirmed that my body knew what to do, and a song came to me from a religious service that I had been to years earlier: “I release and I let go.” So I sang and hummed that refrain throughout the night.

When I felt crampy, I sat on the toilet and leaked a few drops of blood and mucous. When it passed, I tried to rest, but I just couldn’t get comfortable, so I headed back to the toilet. (Props to my husband who had installed a heated seat a few months earlier!) For hours, I kept crossing the threshold from the bedroom to the bathroom, waiting for my water to break. I was monitoring my ability to think straight. Around 1:00am a friend on the West Coast texted. I wanted to write back, “labor sucks,” but stopped myself. I mean, what would be the point in complaining? I was way too compos mentis to be seriously in labor.

Around 2:30, my husband woke up from some sound I had made. My cramps had shifted and I was starting to grunt. After checking in with me, he dialed Shar. We didn’t think that my water had broken. She asked me “is that a contraction?” I responded, “I’m not sure.” I didn’t feel the crampiness of the contractions anymore. It felt different. I didn’t realize that I had made it through transition and was about to start pushing. Shar heard my grunting and said “why don’t I come over?” I was worried that I was unnecessarily bothering her and said, “are you sure?” Shar was just 25 minutes away. She hopped in the car.

We started running another bath because we figured that it had slowed things down earlier in the evening and wanted to do that again. If this was indeed pushing, it was worried that I might not be dilated and could inflame my cervix, which would make it harder to birth later. I’d heard something about that possibility on a freebirthing podcast that had come recommended by a birthing assistant.

On the phone with our doula Yael, she asked what I could feel inside me. I hadn’t thought to check, and didn’t want to introduce bacteria. When I put my fingers inside myself, I was scared to feel umbilical cord and thought that’s what it might be. Yael asked “what does it feel like?” About an inch in, it felt wrinkled, and then it felt smooth. She told me that was the baby’s head. Ahhh, this grunting was pushing. But I shouldn’t be able to make sentences if it was this close. Yael started getting dressed to come over. She told me later that at that point she considered it even odds that she’d find me 1cm dilated or already with a child, but she had never before heard someone make a sentence at that phase.

I was in the bath on my hands and knees and realized that I was pushing. I breathed gently and slowly. I burned a bit, and all of a sudden my child’s head was outside me. My husband was sitting on a stool in the bathroom, trying to figure out how to climb through the glass partition and into the tub. Before he could move, I squatted, caught our child and sat down against the far end of the tub – holding a slippery little one to my stomach. The next moments were very quiet. We held our breath, frozen in fear, looking at the purple, blood-stained baby. My husband took a picture to send to Shar. Then Solomon hollered as if to say “This is new. Where am I!?” My husband and I locked eyes in relief and disbelief.

We recognized the sound of buzzer the second time Shar rang. My husband went to let her in. Yael arrived a few minutes later. I had no idea what to do next and I was spent. Shar helped birth the placenta. We moved my son to my husband’s chest. Yael helped me out of the bath. And we all repaired to the bed for some actual repair. The shots of lidocaine before stitching up some minor tears were the most painful part!

After reflecting on the experience, I can piece together a fragmented explanation of how in the world this happened. For the last seven years, I’ve done a kind of yoga that’s focused on directing your perineum –so when I told myself to open, I guess I knew how. And my grandmother birthed my mom unattended at home. And I’m a wuss about pain, but totally stubborn when it comes to sticking out intensity. I tend to navigate the world by stubbornly trying things until my troubleshooting succeeds. I’m reluctant to ask for help before I know that I need it. All in all, I trust my body. I believe that if there had been a complication, labor would have slowed down and my body would have signaled that it needed help. My inner monkey knew how to do this after all. And although this birth was an outlier in so many ways, in the end Solomon was born at 40+5. For that to be the average, someone’s gotta deliver then. And this time around, that someone was me.Birth