Tuesday, May 4, 2010

Labor and Delivery

Back in the day, Marcos and I used to joke that when we started having kids we would probably be too poor for good insurance, and that we had best come up with another plan. Our plan was to rent a minivan, outfit it with sheets, blankets and garbage bags, and then park it outside the E.R. at our local hospital, where Marcos would deliver the baby. Well educated, courtesy of "Child delivery for Dummies" and some you-tube videos, he would skillfully deliver our baby and we would live happily ever after. Unless of course, there were complications or he biffed it, in which case we would simply pull up into the E.R. and... voilà! Instant help. (The ideal plan A didn't include any complications or biffs though, since the only cost we could afford to incur was the rental for the minivan).

But miraculously, I have insurance. So we opted for plan B.

And this is the story of Plan B. More than three weeks after Giovanna's birth day, I have finally sat down to piece together the story of how she came into the world. It required notes from our little bedside notebook and notes from Jo, our doula (birth coach), to put the story back together. It has been a victory for me to get the details in order, because the span of a three-day labor and my sieve-like memory had given me the impression that I was not going to be able to recapture the experience like I had hoped. But here it is...

April 7th

This was the night I was scheduled to go into the hospital to begin induction, if you remember that story. Ironically, after canceling the induction and spending a great day with our family, I felt my first ever contractions that very evening. At midnight, while watching Eagle Eye in the squatting position, I felt a sudden release of liquid and thought that my waters had broken. I didn't tell anyone for fear of raising false hopes, but after going to the bathroom, I privately started paying attention to my contractions to see if they would intensify.

April 8th

Through the early morning hours the contractions continued, although they were still very light and sporadic. At 3am, as Marcos and I were going to bed, I felt repeated gushes of water, and felt sure that my waters had broken. At 4am I called the midwife at the hospital to let her know that things were starting. The midwife on duty was Cathy, and she recommended that I rest for an hour on my side, and then pay attention when getting up to see if there was another outpouring of water after giving it time to pool. We woke up after a rest and called her again, to report no pooling of fluids. She recommended that we wait before coming into the hospital, and said that she doubted that my waters had broken, because broken waters continue to leak for quite a while.

At 9:30am my contractions were regular and about 5 minutes apart, so we checked into the hospital to have a non-stress test for the baby, and to see if the liquids were indeed amniotic fluid. The midwives had switched shifts at 7am, and the new one on duty was one of my favorites, Meg Berreth. She did an exam in triage and confirmed that it was not amniotic fluid, which meant that my waters had not yet broken. She guessed that it had been a watery mucus plug passing. At that exam, I was only 1 cm dilated, 80% effaced and at a -2 station. Meg told me that she hoped that I would be coming back later that day while she was on duty because I had amazing pelvic bones for birthing, and she wanted to deliver my baby! We were discharged and returned home to sleep and rest.

After a relatively contraction-free day of picnicking outdoors at Duke Gardens with our parents, we played Rummikub in the evening and I felt more slight contractions.

Picnicking at Duke Gardens with Marcos' parents and my mom!

April 9th

At 5am I woke up with contractions strong enough that I could no longer stay asleep, and so I shook Marcos awake to start timing them. As he timed contractions, he lay next to me and coached me through relaxation techniques that we had learned from our Bradley Methods book. He had been nervous initially about the pressure of providing so much assistance, but in the heat of the moment, he was wonderful! We called Jo our doula at 6:45am and Marcos and I met her at the hospital at 7:45. With the 7am shift switch, a new midwife, Nancy, gave me an exam and my cervix was only dilated 2 cm. After an hour of triage, I was discharged at 8:45am and Jo returned with us to labor at our home. It was the second time I was discharged from the hospital.

At 11am I needed a change of scenery, so Marcos, Jo and I went to Whole Foods to have a healthy lunch and continue laboring while moving about and being distracted. I had all back labor (which means that the pain of my contractions was located solely in the small of my back), so during contractions our routine was that I would lean on Jo's shoulders to support and relax my upper body, while Marcos provided counter pressure by digging a tennis ball into my back, or squeezing my hips together. The pressure required to counter the pain of the contractions needed to be extremely strong, so their job was tough! Both Marcos and Jo were sore for days following my labor.

Back to the story... In retrospect, I probably should have been more self-conscious while laboring in the middle of Whole Foods, but it was all very exciting and exactly where I wanted to be, with all of its fruits and chocolate delicacies to ogle at. While there we ran into Rebecca (my friend/boss/photographer) with baby Owen, who was thrilled that the process of labor was starting! When we got up to leave the store after eating lunch, a woman at the neighboring table said that she had been timing my contractions and that I had better get to the hospital soon. Little did she know! Our next destination was the Bolinwood trail. We walked about a mile or two in the shady greenery and talked, all the while pausing every few minutes for contractions. It was a beautiful day to be outside.

After our outing, we rested and labored at home for a few hours in the afternoon. In the early evening, Marcos and I took our parents to Trader Joe's to get out of the house. As it was a smaller store than Whole Foods, the employees were much more concerned when they saw me having contractions in the store. Many told me about the bench against the wall, and asked if they should call someone! It was the first time I had seen concern on the faces of those perma-cheerful Trader Joe's employees. I told them I was just having labor contractions and that I was fine.

On our way home, Marcos' father hopped out of the car at a red light and grabbed us a Daily Tarheel newspaper so that we could have a memento for Giovanna's birth day. (We were so ambitious! It wasn't until we got home from the hospital after Giovanna's birth that we realized that we had newspapers for April 8th and 9th, but not the 10th, when she was actually born...).

When we arrived at home, the contractions that had been building all day were becoming very intense. We used contractionmaster.com to time them and I labored with my upper body draped on the birthing ball for a while and then moved into the hot water of the shower with Marcos. We kept the bathroom door cracked open so that he could yell, "Contraction!" when one started, and "Stop!" when it ended. By clicking on a mouse, Jo was able to keep a running log of the frequency and duration of my contractions. Generally, they were still about four or five minutes apart, but they were becoming very intense and were lasting for a minute or longer.

At 7:30pm we felt that it was time to go back to the hospital. In triage, the midwife Nancy examined me and announced very apologetically that I was dilated 2.5 cm. After an entire day of intense back labor, and after hours of increasingly unbearable contractions, my cervix was only .5 cm. closer to letting my baby out than it had been that morning. Someone even mentioned that my contractions were not yet strong enough to open my cervix. Not strong enough?! For the first time during labor, I sobbed. Marcos was parking the car, and when he came in he held me while everyone else in triage waited quietly and let me cry. I remember telling them that I was so disappointed, and that although I knew logically that cm. dilated was not the best indicator of when she would arrive, there was nothing I could do about the overwhelming disappointment that I felt. That was the lowest, most dismal moment of my labor experience.

After monitoring me for an hour or two and having me drink water between contractions until I was hydrated enough that everything was checking out well, Nancy lovingly said that if I really wanted my labor to be as natural as possible I would do best to return home and continue laboring there. It was the third time I had been discharged from the hospital. Nancy gave me a sleeping pill called Ambien so that I could try to sleep between contractions, and we were home again by 10pm.

April 10th

At 1am, after a few hours of fitful, awful, drugged sleep interrupted by relentless and intense contractions, my waters broke. By 2am we were again at the hospital, this time with Jo, my mother and the hospital bag. Because my waters had ruptured, I was finally admitted, and we requested a room with a tub so that I could continue laboring in hot water. My sweet husband Marcos and my sweet doula Jo, who had barely slept in many, many hours, each took a shift in the wee hours of that morning pouring warm water over me in the tub and helping me through my contractions. I was still very delirious from the Ambien and can hardly remember that entire stretch of time. The midwife had kindly given my mother the special midwife room with a real bed, so that she could rest while I was laboring.

At 5am I came out of the tub, and at 6am I asked for an epidural. I had hoped to make it through labor without one, but I had also come into the experience open to the idea of needing a epidural in the case that my novice body progressed so slowly through its first labor that my exhaustion would stretch my capacity. Well, my capacity was definitely stretched. After the exhaustion of 24 hours of sleepless labor, I was ready to rest.

At our first meeting a week prior to Giovanna's birth, and after sharing with her that I was hoping to have as natural a labor as possible, Jo asked me to choose a secret code-word in the case that I was seriously in need of an epidural. I had chosen the word "kit-kat" (because the kit-kat song goes, "give me a break, give me a break..." and I felt like I would feel that way if it came time for me to have an epidural), and finally on Saturday morning it was kit-kat time. At 7:30am I had an epidural. I could feel the anesthesiologist weaving the thin tubing down my back, and sitting perfectly still through contractions was absolute agony, but once the epidural had taken I sank into my first deep slumber in three days.

A few hours later I woke up feeling extremely refreshed. The window was open and letting in glorious sunshine, everyone around me was awake and happy, my nurse Laurey was kindness personified, and the midwives had rotated so that now I was being cared for by Susan Nichol, who I had always really liked. I couldn't feel my legs and it was strange having two massive dead weights instead of moving limbs, but it was a price I was willing to pay. Susan examined me and while I was sleeping I had dilated to 7 cm. After shooting the breeze with Susan and enjoying everyone's company, they let me rest again, and I consented to having two drops of pitocin added to my drug cocktail every half hour so that my contractions would remain intense enough to continue opening my cervix.

In the early afternoon, I woke up and was nearly fully dilated. The midwife Susan used her ultra long crochet hook to clear the last little bit of membranes that were blocking Giovanna's head, and suddenly it was time to push. Stage 2 of labor had arrived! Finally!

At 3:30pm I started the most satisfying part of my entire labor process: pushing! Although the epidural had fully wiped out feeling in my legs, I was able to feel the "undeniable urge" to push and bore down spontaneously and without coaching. The nurse Laurey and midwife Susan were both full of praise, and gave some tips on how to make the most of the pushing contractions. They were both impressed with the progress I was making, and believe me, after a day of feeling frustrated at my body for not progressing, I so needed to see the change I was making because of my hard work! At the onset of each contraction I took two slow deeps breaths, I gripped my own legs down near my bum and give the best three pushes I could before the contractions passed. I had hoped to push in the squatting position or with a squatting bar, but the epidural made that impossible; instead, I was at a 45 degree angle on the bed with my mom and Jo pushing my legs back into my body to open up my birthing canal during contractions, and replacing them in the stir-ups between contractions.

And Hallelujah! After only a half-hour of pushing and maybe 10-12 good contractions, Giovanna was born at 4:03pm! It was one of the most exciting half hours of my life. After the first two or three contractions the black hair of her head started emerging, and a large mirror allowed me to see what was happening, which helped motivate me to push harder. When her head had nearly cleared the tunnel, Susan had Marcos wash his hands and put on gloves. Per his request, Marcos was able to hold her head as it emerged and catch her body as I pushed her out. It was incredible... Susan squirted oil to lubricate her exit so that I wouldn't tear, and she worked hard once Giovanna's head was out so that her shoulders would have an easy exit during the next push, but she stepped aside to let Marcos share in the experience of delivering our baby, and what a gift it was! He held her puffy red body in his big hands, she gave a good cry, and then he laid her on my stomach and cut her umbilical cord.

We finally had our baby girl.

With my mom, baby Giovanna and our midwife Susan Nichol

After nursing her, snuggling for a bit, and admiring her wild head of hair, perfect features and long fingers and toes, all at once Giovanna's welcoming party arrived! Rebecca and Dena showed up to take pictures of one-hour old Giovanna, and our Brazilian friend Aline showed up with Marcos' parents after kindly picking them up from our apartment to join in our celebration. It was perfect. I was completely high on endorphins and feeling fabulously, Marcos was being the most attentive and loving new daddy possible (the hospital staff called him the "baby whisperer" and asked him if he wanted a job), and it was nothing but joy in that hospital room. I hope to remember that feeling for a long time.

When we met with Jo one week after Giovanna's birth to recap the birth experience, she said, "I think you were handed one of the most difficult labors possible". Having the benefit of nothing to compare it to, I actually thought it went rather well. We felt like we were as well prepared as we could have been, I had the natural labor experience that I had been wanting, and then in the end, when it was clear that my body was novice and wasn't quite getting the hang of dilation, I had an epidural, minuscule amounts of pitocin, and had a great time pushing her out.

And when the end result looks like this, how could it have been anything but just right?


Elizabeth said...

She is so darling!
Way to go Metta! Back labor is so much harder, I am glad your midwife had method for helping you through that. It makes all the difference!

Lauren said...

She is so cute. What a great story. You are an amazingly strong woman!

Abbie said...

I'm all teary. I love birth stories. You are amazing! That was a long labor (duh). I'm so proud of you! You handled it perfectly. My favorite part is that Marcos caught her. What an amazing experience! And look at the result! She's so beautiful! Good work! Very good work!

Love to you and your sweet little family.

Headle said...

I'm so proud of you! What phenomenal strength and endurance you showed through the entire labor! I love that you labored in Whole Foods, Trader Joe's and a walking trail...you are amazing!!! Most women, uh hum...me, would be at home whining, ha ha! Way to make the very most of the experience!

Giovanna is so lucky to be coming to such a loving and welcoming home! It really is so cool that Marcos got to be the first one to welcome her to the world. What a beautiful moment!

Thank you sooo much for taking the time to share that with all of us! Its such an inspiring story! And Giovanna is sooo pretty!!!

The Kammeyers said...

Thanks for sharing this, Metta! In preparation for my own first labor, hearing the experiences of others is really quite priceless. :) I can just picture you pushing like a champion. Way to go! Also, I love your code word "kit kat."

SiN CiTy StRoBeHnS said...

Oh my goodness Metta!! She is sooo gorgeous!! Wow, you did great! And you are soooo much stronger than I am! Your labor does sound extremely hard. It was crazy to think how different our labor stories were. You are amazing! Congratulations!! We love you guys!!

Drew and Alicia said...

Ya! Thanks for all the details! Helpful for me since currently my widwife is not allowing me to be induced this time! I am scared and don't know what to expect. What a long tough labor. Good work! I loved that your story doesn't include TOO happy or TOO horrific turns some stories have that just cause me anxiety. Your story instead was inspiring! And helpful! And funny!(Loved your birthing in stores!)

Prouses said...

Good Job Metta & Marcos. It was a pleasure to help your family and be there to see fresh from Heaven Gigi.

Cheryl said...

I have been anticipating reading this story for weeks; thank you for sharing your amazing story with us! Good job, mama!

I had that same feeling of despair when I was sent home from the hospital only dilated 2 cm after 12 hours of labor (fortunately not back labor). And I only wish I would have had all the loving support you had! I still regret not having you come to be with me when Amelia was born...

Giovanna is so beautiful. I love all that dark hair! I hope Dave and I can meet her soon!