Labor Play-by-Play (Long!)

I figure I want to record our labor story for my own memory and to pass on to others (and perhaps learn from/reference for any other future childbirth adventures). Unless you are particularly into childbirth feel free to skip this post…(though as a reminder, for the latest Sean fix, check out our Picasa page where we upload pics daily right now).

For those unfamiliar with labor (and I was until we knew we were pregnant), as context you might want to read a quick overview like this one from Baby Center. I feel like Chris and I both were well-prepared for the process though various classes (though we did not do a set curriculum like the Bradley Method), prenatal yoga (I used breathing techniques and positions I learned as an amateur over the past few months), being nosy to ask lots of people about their own experience, and lots of reading (I found the new Our Bodies Ourselves pregnancy/childbirth guide and Ina May Gaskin’s latest book helpful, especially because they had lots of birth stories as well as information). We sought out the Family Health and Birth Center to support our goal of a natural birth (plus the folks were so fabulous). And, for me it was so amazing and important that Chris was completely a part of the whole preparation and coaching process, and I love that he was present for every class, every appointment, and read up as much as I did.

First stage: Early labor (at home, and two trips to the Birth Center)

On Sunday (October 26) I started to think things would happen soon (and was impatient!) and I woke up on Monday morning with what I thought was an annoying backache that would come and go… but had been waiting for something that felt like a tightening of my abdomen in the front, not in the back. After a few hours of uncomfortable cramps (and shower #1 of what was to be 5 over the course of the labor—that was my most comfortable place to be), I called my Mom who then shared that’s how all of her labors started. So, she started getting ready to hop on a plane out of Logan while I had periodic contractions while watching TV and putzing around… they were easy to deal with. Kate ditched work (and Chris had never gone in) and we chilled out in my apartment in the morning watching The Wire (AWESOME show, btw… with a complex enough plot and character development that I needed them to pause during contractions so I could follow along). We were joined by Mom at 1ish, Chris and I took a slow walk around Adams Morgan, and by midafternoon I was at that threshold of 5-1-1; most providers want you to have contractions that are 5 minutes or less apart, 1 minute or more in duration, for 1 hour. I’d given the midwives a heads up that things were starting in the morning and Sierra suggested I call back after two hours of contractions 5 minutes apart or less. It was obvious my labor wasn’t going particularly quick, but after a few conversations with Sierra we met her at the birth center around 8 pm.

At 8 on Monday, Sierra examined me and I was only 2 centimeters dilated—the threshold for admission to the birth center (and, I think, most settings) is more like 4-5 centimeters unless you have complications. While labor had been pretty manageable, it was still work and I was VERY frustrated that I hadn’t progressed further. We discussed either taking action to get myself into active labor (walking stairs, maybe castor oil) or trying to slow stuff down a bit to get some rest for what was obviously going to be a long haul. Feeling pretty tired and not excited about castor oil quite yet, I opted for the latter and, at Sierra’s suggestion, took some Benadryl and headed home via Kate’s—she has a big tub and I thought, being a bathtub sort of gal, that would be a good place to relax and manage my intermittent contractions. I did get a little bit of sleep between contractions that, for a while, really slowed up—15 or 20 minutes apart at some point.

Shortly after midnight as I lay in bed trying to sleep, things really picked up and an annoying pattern developed: I started getting contractions in the front that seemed to be on a totally separate pattern than the back labor. For a few hours I had contractions in the front that were 5-7 minutes apart, and contractions in the back at about an equal pace. Combined, I was having contractions every few minutes or, at times, one long contraction as the front would end right as the back would start. In other words, not at all restful! It was at this stage, in regular pain, exhausted, and frustrated that my body was going through this process so slowly, that I stopped being able to relax and manage the pain the same way and instead found myself dreading the next contraction. I threw up at one point from the pain (which Sierra said was a good sign) and started to fantasize about drugs to help me get through the process.

After laboring for a few hours at home it was time to go back into the birth center, this time meeting up with Lisa Uncles (2 of the 6 or so full-time midwives there are named Lisa… and my 38 hours of labor meant I got to work with both!). At 4 am when she examined me, I was at 4 centimeters—progress but again not as far as I would want given the hard work of it. My blood pressure (normally low) was also very high the first time, and still a cause of concern at a second reading—a sign of the way I was not relaxing through the pain anymore. I was still not far enough along to be officially admitted but, after a bit of whining on my part (driving across town over bumpy roads, exhausted and in pain, was not something I enjoyed), Lisa let me camp out in one of their laboring tubs and see how my labor progressed. I had been holding out for their tubs—again, I’m a water person and had been told that the tub was “better than an epidural”. Unfortunately, the tub did nothing for me (I found that showers worked better), maybe because of the strong back-centered contractions—I felt trapped and wanted to be mobile instead.

First stage: Active labor (at the Birth Center)

In between contractions in the two hours in the birth center I struggled with the decision to give up my dream of a natural birth—and I am still very conflicted now (it’s comforting to be typing this as Sean sleeps in a sling in my front, making cute little sleep noises). I like to think of myself as strong, mentally tough and very comfortable with my body, and I had done what I considered a lot of preparation for the natural birth process. But, I was stressed, tired (physically and mentally) and totally disempowered by the idea that I had so much further to go. In one of the tougher decisions I’ve ever made, at 6 am on Tuesday I told Lisa U. that I needed to get some help to manage the pain. While Lisa and the other midwives there are very committed to natural labor, and the birth center setting, I think she could see that I had also thought through and struggled with the decision. Lisa did an exam to make sure I wasn’t going to pop out a baby in the car and I was at 6 centimeters—at least progress (and a sign I’d been in active labor for two hours), and momentarily I debated whether to go for it there. But, the road ahead still seemed so daunting so we packed up to drive over to Washington Hospital Center, where the Birth Center midwives also deliver. Lisa shared that this outcome might have been where we ended up anyways given my high blood pressure. Heading over to the hospital, I was relieved with the thought of getting help for the pain (the strategy was to get nubain, a narcotic that helps numb the pain, and not an epidural) but sad that we were driving away from my dream of a natural birth at the Birth Center.

First stage: Active labor (at Washington Hospital Center)

We were admitted to Washington Hospital Center around 7 am and met up soon after Lisa Ross, another Birth Center midwife, and Nicki, a labor and delivery nurse. I’ve never really been in a hospital before, and certainly never been admitted, so the whole process was strange. We called up Kate and Mom to give them an update and they headed to the hospital to join us for the “homestretch”. I was limited to 3 support/coach types, so Maura and Jen weren’t able to join for the process as planned at the birth center.

I had hoped that I would get drugs almost immediately afterwards—having pushed myself to do it without, when I gave in I was impatient. But, there were lots of tests to run (blood tests, I guess… I’m a little foggy on it) and so I labored on without pain medications. Lisa examined me at about 8:30 or 9 am and I was at 8 centimeters—again, progressing far enough to make me contemplate going for it.

Transition (and getting the epidural)

8 centimeters meant that I was on the edge of the transition phase, meaning the toughest part of the process from what I understand. 8 centimeters also meant that I was too far along for nubain, since Sean’s ability to breath after birth could be compromised if he arrived too soon after I got narcotics. My choice was either pain-free or an epidural. I was much more frightened of an epidural than a narcotic, since epidurals are much more likely to trigger all sorts of other interventions ending in an emergency caesarean. We had to wait 30+ minutes for the results of some other test before starting the process of getting the epidural. So, I labored on, hard (but managing the pain better than I had in the early morning), in the shower in the hopes that I’d get further along and then could do it drug-free.

One last exam before the epidural, and I told myself if I was at 9 centimeters or beyond (basically, had progressed further) I’d soldier on without pain medication. Frustratingly, I was still at 8 centimeters. Disheartened, I decided to get the epidural. Of course, I was scared about all that could be triggered by the decision: worse outcomes for Sean, the chance of side effects short- and long-term for me (one should not mess around with the spine lightly). I felt that my family, especially Chris, were supportive either way and Chris, given his work preparing for birth, really got how tough the decision was (as a measure of how tough it was, and my feelings about it now, I confess I’m typing this now through tears—and thankful that I know how the story ends rocking this beautiful and healthy boy through a morning nap). I won’t get into the play-by-play of the epidural but it was interesting, but also tough since I was having tough contractions and was stuck in bed as they got me set up.

Then, the epidural kicked in around 10 am. I wasn’t sure what to expect—some friends (example: Lea) still felt a lot of pain but others (example: Stacey) had no sensation at all and slept through the toughest part of labor. As it turned out my full-strength dosage was the latter; quickly I felt almost nothing below my waist, and soon lost the ability to really move my legs. I couldn’t sleep despite my physical exhaustion. I think I was still worked up from the decision to get the epidural, a little freaked out about the effects of the epidural (ex. I was very cold despite lots of blankets), nervous about what other interventions were in store, and excited that I was soon to become a mother.

As is common, the epidural really slowed down the progress of my labor—we had hoped I’d dilate those last two centimeters in about two hours but it was midafternoon before it seemed like I was close to fully dilated. Lisa R. brought up the possibility of pitocin to speed up labor and did such a great job of making me feel like I could make a decision about it—yes, it would again increase the likelihood of a cesarean but also could help Sean get out faster, a better result perhaps for him. Luckily, his little heartrate was going great through the whole process—a sign that he was doing fine and we probably didn’t need to push things further for his sake. I feel strongly that, if under the care of a more typical medical provider, impatient with my long labor and less committed to reducing the number of interventions, I wouldn’t have felt I had options—payback for seeking out the Birth Center model of care.

Second stage: Pushing

Finally, the last little lip of my cervix was cleared and at 4 pm Tuesday I entered the pushing phase—kicked off by Lisa breaking the amniotic sac bubble created by his head (my water had already broken but it opened closer to the top). In discussions about setting up the epidural, I’d asked that the strength by reduced by half for the pushing phase—I wanted to be more in touch with my body and more of an active participant in the birthing of our little boy. In addition to the fetal heartrate monitor I’d had on since the epidural, we also started to consult the contraction monitor (probably not the official term)—in the beginning as the epidural was just wearing off, I could hardly tell when contractions were starting to guide my pushing. I was very excited—time for me to work and make stuff happen! And, through the conversations with Lisa it felt to me like I needed to work in particular to help my body along and therefore avoid the pitocin. I gather my technique was somewhat unusual—during contractions I would take a series of breaths and then push hard while blowing out air (I guess most folks hold their breath). Breathing out just felt right and really followed the breathing techniques I’d learned in yoga.

The 2.5 hours of pushing was perhaps the toughest thing, from a physical endurance standpoint, that I’ve ever done. Again, this was really empowering for me—my overall efforts to be in shape and healthy, and specifically everything I’d done during labor to stay active (ultimate Frisbee, carefully, through my first trimester; tennis, carefully, though the second trimester; and the 3-7 miles of walking I’d logged daily or almost daily until the day before labor started) were paying off! Seeing that Sean’s heartrate was down during pushing, I was breathing from an oxygen mask between pushing bouts, and my face and a good chunk of my body was bright red from exertion.

Kate used her digital camera to show me the progress I was making and it was, of course, amazing to reach down and feel my son’s head as he began to crown. Lisa and Nicki were great and let the process go along, and my mother, sister and especially Chris were just so wonderful and encouraging. Chris resumed the massaging we’d done regularly the weeks before labor to reduce the odds of tearing (and I ended up not needing any stitches) and, more and more, I could feel that it was happening. As the strength of the epidural wore off I was able to use different positions, including being on my hands and knees (I’d often thought pushing out our baby boy through my 30+ daily cat/cow poses before bed in a failed attempt to get Sean to face completely backwards)—again, I can’t imagine a more traditional provider allowing me to change positions with an epidural rather than just being stuck on my back.

Sean Emerges!

I could tell I was close (and yes, it did hurt but nothing like back labor—it turns out the epidural wore off for the last 10 minutes as the IV bag emptied) and, in a round of pushing, I think I surprised everyone by doing one more push than was my pattern. That was it—Sean’s head emerged!!!! What a relief! The umbilical cord was loosely looped around his neck, which Lisa removed, and with a quick and easy push the rest of his body emerged—too fast for Chris to catch him as planned. This squirmy, crying, beautiful being was placed directly on me, skin-to-skin (I was naked for the whole pushing phase) and it was perhaps the most intense emotional experience of my life. He was placed more on my stomach so I couldn’t see him but I could feel him and certainly hear him! Because there was meconium in the amniotic fluid, a pediatrician was called into the room in case Sean had swallowed some, but I guess she opened the door, heard him squealing loudly, and said “no need for me here” and left. I can’t imagine my child would ever be considered loud! J

We got to cuddle with our arrival, savoring the moments, and Chris cut the umbilical cord. After a while he was just briefly taken to a corner of the room with Chris to get weighed: 7 pounds, 10 ounces, much smaller than we’d thought given our birth sizes and his late arrival. We then tried nursing for the first time and he was a natural! Yoo-hoo!!!!

Third stage: Delivering the placenta

As I’m sure others have noted in the past, it’s anticlimactic but worth noting that I had to “birth” the placenta. I was so focused on those little precious moments with Sean that I didn’t pay much attention, but Lisa remarked that she’d never heard anyone say “that tickled” when pushing out the placenta. I was super curious about this amazing organ that sustained our guy over the nine months and am happy to share a picture if anyone is curious.

Final thoughts

I’m sure no one is still reading this novel-length summary by now, but I figured I should conclude with a few thoughts. When folks remark about the 38.5 hours of labor, I often clarify that the real experience for me breaks down this way: 30 hours of unmedicated labor + 2.5 hours of real work at pushing. I’m still very disappointed that I did not have the natural, Birth Center experience that I imagined. If we happen to have another child, I will go for it again in the hopes that I will have a shorter (typical with later births) and less painful (will explore any and every option to get the baby facing the right way to avoid back labor, which will again make labor shorter). I am so grateful that my choice for an epidural did not send me down that slippery slope of interventions that is so common.

And, we are doing so well, which is what really matters. I’d take a really horrible birthing experience (which I don’t consider mine at all) and great progress on breastfeeding (which is far more important for Sean in the long-term) over the ideal birth but struggles/lack of success with breastfeeding in a second—and we are lucky that breastfeeding is going SO well! I also recovered so much more quickly than I gather is typical—up and walking around, with all my bodily functions working normally more or less from the get go.

Of course, I’m happy to share even more or clarify if anyone is interested. All of your good wishes (before, during, after) and support made the labor and delivery process much easier. And Sean, if you are reading this one day (and I hope you will!), I would do it all again in a second for you!