January 11, 2011
Preparation for my son’s birth actually started before I knew I was pregnant. I had been given an episiotomy when Madeline was born and suffered a fourth degree laceration. Everything had healed well, but I was concerned what it might mean for my next birth. I raised this issue with my midwife at my six week follow-up appointment and was told that the American College of Obstetricians and Gynecologists actually advises providers to counsel patients on electing to have a c-section rather than risk another major tear and potential incontinence. A c-section seemed like a radical step to take to avoid tearing, so I pretty much dismissed that as an option. I vowed to do my research before I had another baby.
The midwife brought up my “fourth degree” at my first prenatal appointment for my son. She asked how big my daughter had been and was shocked that she was only 6 lbs., 7 oz. and I still had an episiotomy. I was assured that one would not have been done if it hadn’t been necessary, so there must have been a good reason. I was counseled on the c-section option, but told her that I really was not interested in electing major surgery to avoid a tear that very well may not happen.
I heard about the c-section option and risks of another fourth degree tear at almost every prenatal appointment during my pregnancy. Only one of the midwives came right out and told me that she definitely agreed with my decision. I think they all thought I was doing the right thing, but only one really vocalized it. I did some light internet research and read through some message boards where women had posted a similar question and shared stories of serious tears or episiotomies with one pregnancy and how they handled the risk going forward. Almost every person who posted her story proceeded with subsequent vaginal births and relied on pushing positions and techniques intended to avoid tearing. A large majority had only a minor tear with subsequent pregnancies or no tearing at all. The most important piece of advice for protecting the perineum was to avoid bearing down and attempting to really force the baby out. It was a much better option to really let your body do most of the work and not try to rush the process. “Spontaneous pushing” combined with position really seemed to lead to the best outcomes. Water births were also recommended. I had wanted to avoid bearing down and holding my breath during pushing with my first child, but when the time came I was so anxious to be a really active participant and so ready to push her out that I was forcing it. I was determined to really let my body do what is was made to do and let nature take its course.
I read some of the same books that I read with my first pregnancy and watched The Business of Being Born three times. I found another documentary with a similar theme and took one big thing away from it: for many women, birth is a very solitary process. There can be too many cooks in the kitchen and for many women they have an easier and more satisfying labor when they are left alone to listen to their bodies and “go with the flow.” This really stuck with me because there was a slight chance that I was going to be somewhat alone for this birth. My husband was in Afghanistan and would not be able to come home. My mom was arriving about five days before my due date, but the baby might come before then. I had people here ready to help, but in the worst case scenario I would need someone to drive me to the hospital and then stay with Madeline. In the unlikely event only one person was available, I was going to go it alone, without a close friend or family member to support me.
Luckily my son did not decide to arrive until after my mom got to town. The day my labor started I actually had an appointment for a fluid check and non-stress test. According to one midwife I had seen I was consistently “measuring small,” and despite a growth check a few weeks earlier that was normal, she was still concerned. I was only measuring three weeks small, and according to my research three weeks small or three weeks large was nothing to worry about. This midwife stressed me out a little bit because I knew I was small and was constantly being told how small I was. Until she sent me for the growth check I attributed my size to the fact that I make smaller babies and I’m tall so the baby had more space to spread out. So, on a Monday morning in January I drove to the hospital to make sure everything looked okay. I started having some contractions before I left, but nothing regular. When I arrived for my appointment I had one contraction that definitely got my attention. I actually had to wait it out in the car before going in. The fluid check and non-stress test were fine and the contractions were still coming but very irregular. I went home and took a two hour nap that afternoon. Little did I know I was resting up for the big event.
It was around 5:00 that things started to get more intense. My mom was feeding Madeline dinner and I just hung out on the couch having regular contractions. They were still pretty far apart, but I was starting to think this was the real thing. My sister-in-law was on call to come over and watch Madeline, so I gave her the heads up that it was probably going to be tonight. I spent the next few hours on the couch timing contractions and getting a little nervous about all of the logistics. I wanted to labor at home as long as possible, but this was my second baby and I didn’t know how much faster he might come. I needed to call my sister-in-law to come over, but I didn’t want to call her too early. I also didn’t want to wait until the last minute and be stressing out that she would not get here in time. Finally, around 10:00 or so I called her and asked her to just come over. I knew I was going to head to the hospital sometime that night and I thought it would be better for her to come over and just go to bed here rather than have to call her at 2:00 a.m., wake her up and ask her to come over right away. While I was waiting for her to arrive things really started to pick up. I think that knowing she was coming over made me relax and allowed labor to start really progressing. Contractions were getting more intense and closer together, but I could still talk through them and they were pretty bearable. So, even though they were about 4-5 minutes apart while I was up and moving around, I was still nervous that I was not that far along. I did not want to go to the hospital and be told that I would be better off going home. My mom had just gone to bed and told me to wake her up when I wanted to leave. She requested that I give her enough time to take a shower. I thought she was joking (she wasn’t). Not long after she went to bed I knocked on the door, went in and told her that I wanted to leave when my sister-in-law got there. I just had this feeling that it was time. I think we left the house around 11:00 and arrived at the hospital about 20 minutes later. Despite several contractions along the way the ride wasn’t too bad. She dropped me off at the emergency room, and as I was about to get out of the car we saw a family of raccoons pass in front of us. It was weird to see four or five raccoons walking by the entrance of the hospital and something I won’t ever forget. I opted for the wheel chair up to labor and delivery and got there in no time. It was very quiet that night and I was the only person in triage. I asked which midwife was on call and was a little disappointed when they told me. I can’t articulate why I was disappointed; she was just one that I wasn’t really thrilled to deliver with. She ended up being awesome.
The midwife arrived with a student midwife. She asked if I would mind if they both checked me. I groaned and made it clear I would rather not because I think getting my cervix checked it almost as uncomfortable as labor itself. I told her that assuming her check didn’t hurt too much I would be more than willing to help with the student’s education. I was checked and told I was seven centimeters. I was a little surprised to be dilated that much considering how good I was feeling. I was glad to be admitted and told the midwife that I wanted to use the birthing tub.
I was wheeled into my room and met my labor nurse. She proceeded to ask me a million questions, the answers to which I was sure were already in my chart. That process took forever because I could only talk in between contractions. Then, despite being clear about my intention regarding no pain medication, the anesthesiologist came in and asked me the same questions. Just in case. I was finally able to get into the tub at about 1:00 a.m. and it felt great. It was so calming and relaxing. On each contraction I would just close my eyes and breathe through it. My nurse was very nice, but felt compelled to be my cheerleader. In between two contractions I asked if I could make a request. My mom, the midwife and the nurse were all in the room at the time. I said, “I have one request. When I am having a contraction, please do not talk. I just need complete silence.” Everyone agreed to cooperate. The next contraction came and all was quiet until the nurse started whispering, “You’re doing great. Krista, you are doing so well.” She just couldn’t help herself. At the time I was trying to visualize relaxing things like waves crashing into the shore and she was making it really difficult. I realized I was just going to have to try harder to block her out.
Around 2:00 my water broke. My water had never broken with my daughter, so the sensation was foreign to me. It literally felt like I had been uncorked. Around that time I felt like I needed to push. Almost everyone was still respecting my need for silence and I felt so in tune with my body. Rather than holding my breath and pushing I was very vocal. I let my mouth kind of hang open and I let out low moans. I could feel myself opening up more and the baby descending further. The only time I questioned my ability to push him out was around the time he was crowning. Because I had the episiotomy with my first baby I never really had the sensation of pushing her head out. While in the tub with my son I actually thought to myself, “There is no way his head is going to fit. I might have to ask for an episiotomy.” This crazy thought disappeared as I was swept up into another contraction and the overwhelming urge to just keep gently pushing as my uterus and gravity did a lot of the work. Around the same time he was crowning, the nurse decided she needed to do a heart rate check. Between the water and the fact that he was way down in the birth canal, she was having a hard time finding his heart beat. At this point it was her only job, so she was committed. After re-positioning myself a few times and working through a few contractions she was still unable to find the heart beat. I wasn’t really worried and was very thankful for my midwife. She told the nurse to stop trying and just let things continue. She was so calm and seemed to really trust in me and the process. A few contractions later and his head was out. One little push later and I was pulling my son out of the water and onto my chest. Despite the measurements he weighed in at 7 lbs., 6 oz. and was perfectly healthy.
We hung out in the tub for awhile and waited for his umbilical cord to stop pulsing before my mom cut it. I got out of the water to deliver the placenta and was able to ask my midwife if I tore. I was anticipating at least a small tear, but it turns out everything was completely in tact. I was so happy and I think it was the first thing I told my husband when he called.
It was taking awhile for my bleeding to stop, so I was subjected to A LOT of massage on my abdomen to get my uterus to really contract. It was so painful. I think the pain was worse because I wasn’t expecting it. I continued to pass clots and upon closer inspection it turned out that there was a small tear on my cervix that needed to be repaired. Compared to the episiotomy a tear on my cervix was nothing and once I was sewn I forgot it was even there.
My mom went home and was back before my daughter woke up and knew she was gone. Madeline never even knew her aunt spent the night while mommy went to the hospital and gave birth to her baby brother.