Well Rounded Birth Prep: January 2012

I've really wanted to write up this birth story, but it seems so big, too daunting to even begin. I've felt that way with each of my births. I'll give it a shot anyway.

Quick backstory:

2002 Hospital birth of our 1st baby. Unmedicated birth as was my goal, but hospital routines that were not appropriate for my situation led to very difficult and painful recovery.
2004 Our 1st home waterbirth with midwives. I had sought a different model of care with this pregnancy to prevent the problems and pain that happened with my first birth. Healing birth.
2006 Our 2nd home waterbirth with midwives.
2007 Missed miscarriage followed by D&C at 14 weeks 5 days. Devastating.
2008 Our 3rd home waterbirth. Accidental unassisted birth. Long story.
2011 Here we go again... You can see my posts from this pregnancy here.

*****DISCLAIMER: THIS IS A BIRTH STORY. PLEASE CLOSE THIS TAB IF YOU ARE NOT PREPARED TO READ ABOUT DETAILS OF PREGNANCY AND BIRTH.**********

I will also upload (modest) photos from my labor and birth, but these are still labor and birth photos. If you are uncomfortable discussing cervical dilation and how to keep a perineum intact during pushing, please don't read further instead of leaving bizarre comments or telling me that I overshared. Mkay?

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Who's who:
me: Sarah DeGroff
hubby: Rick DeGroff
doula: Tara Gilkey, DONA
midwives: Angy Nixon, CNM, and Dorothy Kaeck, CPM
apprentice midwife: Pia Long, DONA

I was at a prenatal checkup at my midwife's house on Wed. Dec. 21 when I had a bit of bloody show. How exciting! I was 39.5 weeks along, and hoped that would mean onset of labor within the next few days, although I have a friend who had steady bloody show for two full weeks before labor began at 41 weeks along. I really hoped I wouldn't have to wait two weeks, but I was prepared to wait until baby was ready on his own time.

The next few days were spent nesting with joyful anticipation. I had set a salon nail appointments for myself, my mom, and my 7 year old daughter for that evening, and I hoped that getting a pedicure would be all my body needed to let little man arrive.

My 7 y.o. daughter's and my pedicures. We have sparkly snowflakes painted on our big toes.

My hubby took me out to eat after that (while my mom watched our kids), our last date without kids for a lonnnngggg time.

The next day, I got my hair cut, since that hadn't been done since mid-September. A girl can only go so long without having her bangs trimmed.

The next day was my mom's last day with us. (She had come to stay Monday through Friday to help cook and fill my freezer with postpartum meals. A wonderful gift!) I had kind of thought that I would go into labor as soon as I got my mom out of the house because I am rather private about who is around me during my labors and births. I would have felt self-conscious with mom there.

After 3 days of continual bloody show and Braxton Hicks contractions that got gradually more intense and crampy, I did start having stronger and longer contractions as soon as my mom hit the road at 4 p.m. on Friday Dec. 23. I put together my labor music playlist, made red raspberry leaf iced tea/punch and RRL punch popsicles, readied last minute birth supplies and snacks, and headed to bed at a decent hour. (I loved my labor playlist throughout my labor, but the playlist needed to have been twice as long! It was on repeat for a l.o.n.g. time.)

Prelabor/ super early labor, evening of Dec. 23, about 24 hours before the birth. Putting together my labor song playlist on Rick's iPad, from my notes on that notebook next to it.

All night long, I awoke with contractions that were intense enough to wake me up. I had to get on hands and knees over my wedge pillow that I slept on to prevent reflux. I intensely wanted Rick to provide counterpressure on my sacroiliac joints, pressing straight down. Occasionally, I would time my contractions using my ContractionMaster.com iPhone app, but since they didn't seem to be getting closer together, I mostly just tried to sleep in between contractions. All night long, they were from 6 to 30 minutes in frequency (averaging 10-13 minutes apart), averaging from 50 to 90 seconds each, and varying in intensity. I knew that since they were so sporadic, it likely meant things were still very early, and that it could indicate malpositioning. Baby had been ROT for my entire last trimester and it seemed that he was still ROT, judging by where I felt his movements. (ROT = Right Occiput Transverse, meaning head-down with his spine aligned with my right side, facing my left side.) I wondered if his head was asynclitic (head tilted slightly toward his shoulder), a malpositioning which often is responsible for irregular contractions, abnormally long contractions for the stage of labor, contractions that are more intense and painful than they should be for that stage of labor, and piggybacked contractions, which started late morning.

Even though the contractions were as far apart as they were, they were definitely intense and painful enough to want support through them. I found myself watching the clock to see when it would be "late" enough to reasonably call my doula, Tara. Her family lives not far from us, and she basically had to drive by our house to get to her family's house on Christmas Eve, so she had already planned on stopping by to check on me and visit for a bit on Christmas Eve, even if I hadn't been in labor. I wanted to see if she could come earlier to spell Rick for a bit so he could get something to eat, feed our four kids and spend a little bit of time with them, and help me get my grounding. I called Tara around 6:15 a.m. and filled her in. She said she would come over after getting everything ready for her husband and kids to be able to head to her family's house later in the day.

At that point, I figured I was up for the day and took a long shower in the dark by candlelight, letting the water and my playlist soothe me while I let Rick sleep. The water was very soothing to me. I still needed to be in a forward leaning position during contractions, slowly swaying back and forth, and I found that singing along with my playlist during contractions helped me have a relaxed jaw per Ina May Gaskin's recommendations ("As above, so below. An open, relaxed jaw means an open cervix.") A friend had mentioned that during her labor, having familiar songs helped her cope with contractions because she knew the lyrics and it gave her a known in a time of unknown. Maybe it was because I read that, or maybe it would have happened anyway, but I, too, found comfort in my early labor in the familiar lyrics. It gave me something to do, something to focus on other than the contractions.

My plan had been to do a #twitterbirth and post my updates as things progressed (with my doula tweeting for me after I could no longer do so myself), but I was afraid to post that my contractions were more intense or that I had called my doula in, because my contractions were still so erratic. I knew that this was either very early labor or possibly prelabor, but that didn't change the fact that I needed support through these contractions. I didn't want to feel like a watched pot then be embarrassed later if I had to admit publicly that I had called in labor support all for nothing, so I just waited to see what would happen. It was low key and no pressure, since Tara had to drive that direction for her family gathering anyway, so she told me she would hang out with me for a few hours and help me get comfortable, then we would play it by ear. If I needed her to stay, she would. If my contractions slowed down or still weren't in any discernible pattern, she would go on to her family gathering and come back whenever I called her.

Tara got to our house around 10:30 a.m. and took over labor support so Rick could tend to our kids. They both made sure I had enough to eat and drink. By this time, I wanted my electric heating pad on my lower back along with SI countersupport with each contraction. Throughout my labor, I needed to be forward leaning during contractions, either on hands and knees, sitting on the birth ball and leaning forward onto my bed, or standing and leaning onto my bed or onto the bathroom counter. It makes sense that those were the positions that felt right to me, because those positions help babies rotate, especially if they're posterior or transverse (but head-down).

Early labor, maybe 11 a.m. Forward leaning, sitting on the birth ball. Heating pad on my back. Eating Greek yogurt, enjoying distraction from my 3 y.o., and writing my blog on RRL tea labor punch.

Tara suggested wrapping my belly with her rebozo, a thin scarf-like fabric which has many uses in helping get babies better positioned in labor. I wish I had a photo, just for reference, but basically she spread the fabric across my midsection from hips to ribs and tied it tightly behind my back to help lift and bind my belly, to help baby get repositioned. We left this on for an hour or two, then I decided to get in my tub for a bit to try to get my uterus to relax from these long-lasting contractions. My uterus felt tight and painful even after contractions ended, sort of like a charley horse, and a bath can help with that.

11:30 or noon? Trying to relax between contractions.

During contractions. Sacral counterpressure helped so much.

Candy cane scented candles to set a relaxing spa mood.

I continued to eat and drink all day, everything from peanut butter crackers to apples with peanut butter, colby jack cheese cubes, toaster waffles, and chicken noodle soup (which I ate an entire bowl of about 30 minutes before I had my baby). I drank red raspberry leaf tea/punch (and RRL popsicles--yum!). I needed the calories to keep my energy up.

Since I didn't know whether this was "really it" and whether I'd have the baby today, we didn't want to call and bother anyone on Christmas Eve to have them come help us with the kids, so they mostly fended for themselves, playing Wii and watching cartoons on Netflix. We let them open craft and game gifts every few hours to keep them occupied. Here they're opening a Wii Babysitting Mama game from uncles.

My contractions were still averaging 10 minutes apart, but they were painful enough and intense enough that I wanted labor support. Tara asked if I would be OK if she went to her family's Christmas Eve gathering with family 35 minutes away from my house, if my second midwife Dorothy came to be my labor support. Tara left around 12:30, and Dorothy got here around 4 p.m.

I'm not an advocate of routine vaginal exams in labor, but since my contractions were still in that same pattern, I asked Dorothy to check me around 4:30 p.m. Mid-morning, Tara and I had discussed how far along we thought I might be, and based on how intense and painful they were, we guessed 4-5 cm, and that had been hours before. At this point I was hoping Dorothy would tell me I was around 6 cm. Nope. 3 cm. You have GOT to be kidding me. Baby was -1 station and I was 80% effaced. I know that numbers don't technically mean anything, but this was discouraging. That's part of why routine vaginal exams in labor are such a bad idea. This wasn't what I would call routine, though, because we were trying to get info on what was going on with his position and what to do next, if anything.

I spent the afternoon in and out of the tub, in for a while to try to relax and take the edge off, then out for a while to encourage baby to rotate and descend, but all the while, on hands and knees or forward-leaning, with Rick or Dorothy pushing hard straight down on my SI joints. I felt a little self-conscious that I was having such a hard time coping with the pain of these contractions because neither Tara nor Dorothy had attended any of my previous births, so they had to take my word for it when I told them, "I really have done this 4 times before without an epidural, and this doesn't feel like it did before. I promise I'm not being a wuss. I really do know how to handle contractions." They laughed because they believed me and I didn't have to explain myself, but that's just me.

Since my contractions were far apart and in an ineffective pattern, the endorphins that usually bring a mom into LaborLand in a dreamlike state and help mom manage the pain, weren't there. I was in a conscious, alert state throughout the labor. I'm guessing that the endorphins weren't sustained enough from one contraction to the next to be able to produce the LaborLand effect.It sounds like a treat, on paper, when I tell people that my contractions averaged 10 minutes apart for my entire labor, but there's a reason it's not "supposed" to be that way typically. I've had it both ways, and LaborLand is FAR more manageable.

I don't know how many hours it went like this, but for maybe 4 hours, my contractions were painful enough that they felt like transition. I kept telling Dorothy, "I don't know what's going on with this, but I cannot get on top of the pain." One birth affirmation I tell my childbirth class students is "I can do anything for a minute and a half," which is the average amount of time of contractions during transition, the hardest and most intense part of labor. Since my contractions were piggybacking, they totaled 3-4 minutes (combined) and that mantra wasn't cutting it. Dorothy told me, "Just keep breathing. All you have to do is breathe." That made sense to me and was exactly what I needed to hear. I couldn't get on top of the pain, but I didn't have to. All I had to do was keep breathing. I was vocalizing loudly through these contractions, moaning out the pain. Dorothy matched me through the toughest ones, and it helped a lot. I found I felt most right on hands and knees in my tub, with my feet braced against the wall of the tub during my contractions, rocking forward and backward a bit with my contractions.

More challenging to me than the physical pain and demands of my labor was the mental game, knowing that I was "only" 3 cm and "only" in "early" labor. If I had thought it was almost over, I'd have been fine, but I started getting discouraged and crying because I didn't know how I'd make it through if I had 12 hours more of this. Rick had been texting my other (former) midwife, Jennifer Stewart, who had worked with my primary midwife Angy at all my other births. Jennifer moved to California to work at a birth center in November and I was so sad that she couldn't be at this birth. She was not only the midwife who caught my 2nd and 3rd babies, but she is also one of my closest friends. Rick filled Jennifer in on what had been going on, so she called when I was between contractions to try to encourage and buoy me. I don't even remember what she told me. I was a little preoccupied. I had to hang up on her when another one came.

As it approached 8 p.m., Dorothy told me I needed to decide what I wanted to do. I had been up a lot the night before and hadn't gotten much sleep, and I was getting tired and discouraged from all day of labor like this. I could A) try to speed the contractions up and get into a better pattern, B) try to slow the contractions down with either 2 Benadryl or half a glass of wine and catch a nap so we could start fresh and maybe things would be more effective after that, or C) do nothing to change it, and just take it as it comes. My hips hurt too bad from SPD to go up and down the stairs to try to speed labor up. I had been upright a lot and changing positions. I lean toward wanting to let labor chart its own course and take option C) and just see what happens, but I asked her to check me again to gather what info we could for decision-making. I had told her that I really didn't want her to go because I felt like once my contractions firmed up and once my little man got into position, it would all be over, and she wouldn't make it back in time. (Like I said, I had an accidental unassisted birth with my last baby due to the fact that I had a long prelabor and early labor, didn't recognize it once contractions did get more intense and was in denial of transition, and I did not want another unassisted birth.) Dorothy said that if I hadn't made progress, she wouldn't leave me. She would sleep on the couch all night if she had to.

I got out of the tub so I could waddle to my bed to allow Dorothy to check me. The bath water was getting too cool for comfort at that point anyway, so it was time to drain the tub. Then I did something really smart. I asked Rick to go ahead and fill the tub again. He was skeptical because we had been talking about trying to back off on focus on labor since I "wasn't making much progress" and we were going to watch A Christmas Story since it's on TV on some channel for 24 hours straight on Christmas Eve every year. Here's what I told him, verbatim: "Water is cheap." I was afraid that once the urge to push came upon me, whenever that was, if the tub wasn't full already, we wouldn't have time for the tub to fill. I told him that if we need to drain it and fill it again, we could, but I would feel safer knowing it was ready. This turned out to be very important.

I arranged myself on my wedge-shaped pillow that I slept on every night to prevent reflux, and Dorothy checked me. She said that I was now at 5 cm, my cervix was still pretty thick and not very stretchy, and baby was a bit lower, maybe +1 now. I asked her to do Leopold's maneuvers to determine if he was still ROT position as we had suspected. I had to change positions again to move on the bed to a spot with enough room to lie flat for this. She confirmed that he was still ROT. Since I had made some progress, she called all of our birth team to tell them to go ahead and come. Dorothy would begin charting and auscultation (listening to fetal heart tones with the Doppler). She went to her van to get her birth bag with all her equipment, oxygen tank, etc. I got up and grabbed my laptop so I could tweet this:

I also posted on my Facebook page, "Maybe baby tonight?" with a link to my Twitter.

Something in all that changing positions that I had just done helped baby get his head right where he needed to be, because as soon as I stood up after that, I told Dorothy something felt different and I thought I'd need to push soon. It was a feeling of impending dread almost, sort of like when you know you're going to have to throw up, it's just a matter of time. I waddled back to the bathroom. The timeline is blurry. Rick asked if he should turn on the video recorder I had set up on a tripod. I said yes but I knew there wouldn't be enough light. Rick tried turning on the light in the adjoining powder room and leaving the door cracked, but the light was unbearably painful for me. I've read about the importance of having dark during labor, pushing, and postpartum, but this was the first time I had felt that on such a primal level. I told him I didn't care that we wouldn't be able to see the video, just TURN THE LIGHT OFF. (We had 5 votive candles from the pic above as our only light, other than a bit of light coming in from the bedroom.)

With my births, I don't have an "active pushing stage" per se so much as Dr. Michel Odent's definition of Fetus Ejection Reflex. My body does it for me, and I have little or no control over pushing. I can try to slow it down so that my tissues have time to gently stretch, but no guarantees. I got in the tub, and with the next contraction, I was pushing. I couldn't find a position that felt right, though. I felt cornered, panicked. I tried squatting, I tried a kneeling lunge, nothing felt right. Eventually I ended up sitting on Rick's hands like a hammock. Dorothy asked Rick if he wanted to catch, but he couldn't because I was sitting on his hands. Baby emerged like a train coming. Thankfully, I didn't tear (well, a tiny surface tear that didn't need a stitch). That goes to show you what your body can do when birth is instinctive. He cried very quickly after the birth, and his APGARs were 9 and 10.

No wonder it felt so intense. I went from 5 cm and a thick cervix, to baby out, in 14 minutes, including only 4 minutes of pushing. Take THAT, Friedman's Curve!

That was crazy intense. I'm so glad he's out!

We heard a knock at the bedroom door, and our kids said, "We heard the baby cry, can we come in now?" We let them in. I pushed the placenta out then it was time for our 5 year old to cut the cord. This was "his" job that he had asked for more than 6 months prior. It was very special. I don't have a great pic of him cutting the cord, just this pic taken from above, but it captured the moment of how many people were next to my tub. It was a little hectic, but I was glad that my kids could be a part of this.

My hubby is holding baby while our 5 y.o. cuts the cord, and the others watch, fascinated.

The other midwives and my doula were en route when I gave birth and arrived just in time to do all the newborn assessments. One of the wonderful benefits of a homebirth is the ability to shower (in my own shower) then cuddle up in my jammies with my baby in my own bed.

First nursing. It's a team effort.

My 7 y.o.'s job was to help weigh and announce his weight. 8 lb 10 oz! My second-largest baby.

Sweet little (peeling) feet.

My 9 y.o.'s job was to help measure him and announce his length. 21 1/2", so tall! No wonder I was so uncomfortable.

My midwife Dorothy who caught him.

Watching the newborn assessments.

Sign of the times. Daddy doing FaceTime with his brother & parents so they could see the baby.

The rest of my birth team: Doula Tara Gilkey, Midwife Apprentice Pia Long, and Midwife Angy Nixon.

In retrospect, my midwives and I feel that baby's malpositioning was the result of my SPD. His head couldn't easily find the right position and path due to my pelvic instability. It could have been so much worse, though! I understand even more fully now how and why so many malpositioned babies end up to be cesarean deliveries. When a baby is poorly positioned, it makes labor so much more painful, and if I had been in a hospital with an epidural, stuck on my back, I don't know how he would have found the path he needed to rotate and descend. I was so blessed to have him at home.

When I was recounting the events to a relative, and how intense and painful the contractions were, that I just could not get on top of the pain, she asked me if I was scared. I was glad she asked, because I hadn't thought of it in those terms, but I wasn't frightened at any point. I wasn't concerned that either my baby or I were in danger. I knew that we were safe and healthy, and that I had to just keep breathing.

As more time has passed since the birth, I look on it more and more fondly. I fully remember how much it hurt, but the great thing about unmedicated labor is that you feel 100% normal in between contractions. Plus, I felt like a million bucks as soon as he was out. Recovery has been a breeze. I feel strongly that it was necessary to give him the gift of the safest birth possible. It was totally worth it.

I feel that this birth was a perfect example of how pain in labor does not have to equal suffering.

We got to bed around normal time on Christmas Eve (midnight) and the kids let us sleep in until 8 a.m. We came downstairs and watched them open gifts. We were together as a family. I can't imagine what it would be like to be stuck in a hospital over Christmas.

This was a magical Christmas, our best Christmas ever.