“Let labor begin on it's own...” (Lamaze Healthy Birth Practice #1)

On the evening of September 6, this was the one thing I was trying to repeat over and over to myself. I was almost 41 weeks pregnant.

In the months leading up to Ezra's birth, I had done of lot of research into birth practices. I knew what I wanted: a little-to-no intervention, natural, unmedicated childbirth with strong labor support, and a happy healthy baby who would be ready to breastfeed shortly after birth. I knew what I didn't want: an induction, pitocin, an epidural, or a c-section.

I had strong reasons for my birth plan...I knew the risks, pros, and cons of every medical intervention and drug to be used. I was confident in my birth plan. I had a wonderful midwife, a supportive husband, and an educated and supportive mother who was acting as my birth doula.

I started having Braxton-Hicks contractions at 16 weeks. Baby was head-down by 32 weeks, and by 36 weeks I was having very mild normal contractions (more than Braxton-Hicks, less than labor contractions). He was also measuring ahead of schedule. Everyone was convinced that I was going to have the baby early. During the last month of my pregnancy the contractions continued to be strong-enough-to-be-annoying, yet not painful or regular enough to put me into full labor. (This is known as prodromal labor.) I spent many nights on the couch timing contractions up to 3 minutes apart, only to have them stop. I was also having severe pubic pain which I believe to be undiagnosed Symphysis Pubic Dysfunction. (Both the prodromal labor and SPD are what I now know to be factors and/or symptoms of a malpositioned baby...more on that to come.)

At 39 weeks I agreed to an internal check. I was 4 cm and 100% effaced. Mary, my midwife, said “could be 2 hours, or 2 weeks!” Afterward I had some spotting and cramping, which continued to make me think baby was coming soon. We had my mom come down a few days before my due date so she could be close and we wouldn't have to worry about her missing the birth.

At 40 weeks they did another internal check and stripped my membranes. I was seen by another CNM (not mine) and an OB and both said that they figured I would be back having my baby within a few days. I scheduled an appointment for 41 weeks, but they said I wouldn't make it to then.

Commence “Operation Let's Get Things Moving.” Yup, my facebook friends were full of the usual “have you tried castor oil, sex, walking, mexican food, or pineapple yet?” I did try lots of walking, rocking on the birth ball, resting, more walking, more rocking... Again, contractions would come and go just as I thought things were moving along. Called the midwife several times telling her “it could be soon!”

When I woke up on the morning of the 6th (Labor Day - “haha wouldn't it be funny if you went into labor on Labor Day?!?! for the 15th bazillion time...ugh!), I could feel that something was different. I was dizzy-ish, breathless (more than usual), and felt weak. I went through the day hoping that something would happen but no...by that evening, I walked from the couch to the bathroom and felt like I was going to pass out. I stepped on the scale and I had gained 5 more pounds in the last 5 days. I came back to the kitchen and started sobbing. I was not just “tired of being pregnant”...I could feel that something “wasn't right,” but I didn't want an induction. My mom asked if I wanted to call Mary...I begged her to do it for me as I was in tears. Mary agreed to meet me at the hospital the next morning to check me and the baby and see what was going on.

The next morning at the hospital, first thing was to check my vitals...my blood pressure (which had been normal the entire pregnancy) was now sky-high. Mary looked at me and said “we are having a baby today!” I was excited and relieved all at the same time...yet apprehensive because I didn't know how everything was going to play out with me not wanting an induction.

Mary said that we were going to start with an NST, monitoring me and baby, and giving me a chance to rest to see if the blood pressure would stabilize. I did a urine test and was negative for preeclampsia. I was given a heplock IV but I don't think anything was running through it at the time. (Russ went home to get a few things.)

The NST showed that the baby was fine, but the contractions weren't strong enough to register. I got off the monitors and spent about a half hour in the shower relaxing and trying to get my contractions going through some (ahem) other natural methods. Mary said I could eat some lunch so while Russ was out he picked up a burger, fries, and a rootbeer float!

I ate lunch and got hooked back up to the monitors to check everything out again. To my knowledge I wasn't on any medications at the time. I was feeling a little bit better and my blood pressure had stabilized. Sometime in the 1:00 hour (the timeline of the day really is fuzzy in my memory), the baby's heart rate took a dive down (I believe it went down into the 60s, although I'm not sure if that is 100% accurate). Within a minute the room was full of about 7 people (seemed like more!) I remember the head of obstetrics saying “is this for real?!?!” My midwife said, “Aprille, I know this isn't what you want but you are going to have a c-section right now.” They put me up on all fours, head down, oxygen mask on...broke my water and put an internal monitor on the baby. They started preparing me for surgery (signing papers, taking out my earrings, paging the doctor, etc.) Somehow in the midst of all the commotion, with the change of position, baby's heart rate returned to normal. Everyone in the room took a deep breath, relaxed, and they put the surgery on hold. I stayed in the all-fours position for maybe around 10-20 minutes, I'm not really sure, trying to keep the baby stable.  Eventually, they felt like it was safe enough for me to lay on my side and relax. (I now know that fetal distress is another sign of a malpositioned baby.)

The surgeon came in and told me, since we were already prepared for a c-section and since the baby had had some troubles, that we could just go ahead and do the c-section anyway. I looked at my midwife and asked, “Um, is the baby okay?” She said yes. “Um am I okay?” She said yes. “Then no way!” I am not sure what all happened, but I think there was some major disagreements and advocating for my rights going on outside the door to our room. I know that the hospital staff was quite unhappy with our decision, but I put it all out of my head and focused on relaxing. I laid on my side, turned on a guided imagery relaxation set and focused on prayer, keeping my spirits calm, and keeping my baby stable. After about a half hour I changed the music to instrumental worship music. I think this relaxation time lasted about an hour...

Somewhere around 2-3 PM, when I felt more relaxed and it seemed apparent that the baby and I were remaining stable, we sat up for a talk with the midwife. I tried to wrap my head around what was happening. I asked her what would have happened if I had not been in the hospital on the monitors when everything happened with the baby. She responded, “Well, one of two things...either this has been happening all the time and we just didn't know it, and your baby is still fine, or your baby would have died. We will really never know.”

I was filled with thankfulness that I was there in the hospital. Then we began to discuss my options for the continuation of birth. My water was now broken, I had progressed to 6 CM, but I still wasn't having any contractions strong enough to be considered full on labor. Mary was confident that I could still have a natural birth, but suggested that we start a little bit of pitocin to augment my labor and kick-start contractions. I wasn't really happy about it but it seemed like the best (if not the only) option...so I gave my informed consent.

I asked for the birth ball and started rocking on it. We got out a deck of cards and the four of us (my mom, Russ, and Mary) started a game of Canasta. I started out feeling great...but by the end of the game I was barely able to focus on anything except the contractions...amazingly enough we (my husband and I) still won the game!

(you can't see it but I'm on the ball covered with a sheet cuz my water was still leaking everywhere)

A cervical check around 4PM revealed that with the pitocin I had further dilated to 8CM! I was ecstatic and felt that we had made the right decision. Even the midwife said that she expected that our baby would probably be born by 8PM!

I watched the sunset while holding my husbands hand through each contraction. This time is probably the most precious memory I will ever carry with me. I felt so loved, both by my husband and God...I felt like God was giving me a second chance.

This is where things start to get hazy. The contractions got more and more intense...the birth ball had to go and I moved to my feet, where I started just by holding hands with Russ and swaying during contractions. Later he sat in front of me while I bent over and grabbed his legs, while Mary and my mom applied back pressure as my back labor was very severe. I got more and more tired and kept trying to rest by sitting on the birth ball, but it was way too painful to sit.

Sometime around 8PM I started feeling the urge to push...I started pushing, groaning, grunting, and sometimes even screaming with every contraction. They did another cervical check and I was still only at 8CM and 0 station...I was so deflated! I thought sure, with all the pain and intense contractions, that surely I had made more progress than that!

I kept pushing but started to reach my exhaustion point around 9PM. I was still laboring on my feet, unable to take any other position comfortably. I got up on the bed, with the top raised up, and leaned over the back of the bed just crying from the pain and exhaustion, still trying to push. That's when they started saying that I was going to need a c-section. For the next half hour or so my midwife kept trying different positions and internal maneuvering during contractions to help the baby descend...at one point she even got in my face saying “Prove me wrong!” I pushed so hard I felt like blood vessels were breaking in my face.

More checks, no progress (in dilation or descent), a lot of tears, yelling at the OB, screaming, arguing with everyone and everything, begging for more time...I finally consented to the c-section. My heart was still screaming no! I started crying that “I never should have read all those books and sites about natural childbirth!” I kept saying over and over “It's not fair!” My midwife said "You're right, it's not fair!" and was so loving and kind with me...letting me be angry while helping me accept everything. My mom and my husband were also right there with both compassion and "tough love" to help me through. 

(Russ helping me through the "acceptance phase" and surgery preparation)

I think the worst part was knowing “my fate” but still having horrid contractions every 2-3 minutes while they were getting everything ready, wheeling me away, and prepping me for the surgery. By the time the spinal set in and I went numb, I was shaking so badly that they had to strap down my arms just to keep me still. I was physically spent and emotionally numb...it was barely even registering that I was about to become a mother. I had no joy at finally having my baby, just sheer disappointment and grief at having my stomach cut open and being unable to give birth naturally.

It wasn't until I heard Mary say, “I see his lips!” that I realized that my baby was being born... 10:32 PM... and it was amazing. First it was all the amazement about his hair... I got to see a peek at him as they took him to the warmer for a little bit of clean up and then swaddling. They brought him back over to me and I kissed him on his forehead before he was whisked away. My husband stood by my side holding my hands during the whole surgery, even after the birth, and the baby was put into my mother's care while they finished stitching me up. The nurses were taking guesses about his weight, and they came back in and told me he was 9 lbs 13 oz...I felt a little better about the c-section knowing he was such a big boy.

(Daddy and Ezra just minutes after birth)

(Short interjection...My brother Kurt, who had driven the 2 ½ hours from his home while I was in labor, arrived while they were prepping me for surgery. While he wasn't able to be back in the operating area with my mom and husband, he was able to calm Russ down via cell-phone before Russ came in to be with me. Once Ezra was born, Uncle Kurt got to hold the baby and be with my mother in those first few moments of his life.)

I got back in my own room somewhere around midnight and got to hold him and try to nurse him. My legs continued to shake into the night and neither Ezra nor I slept much. Thus begins our recovery story (http://www.beautifulinhistime.com/blog/birth-announcement-and-recovery-update) and breastfeeding journey (http://www.thebreastidea.com/2011/02/mom-of-week-5-aprille-d.html).

(Holding Ezra for the first time)

I have no shame in saying that the night Ezra was born was one of the most difficult, traumatic, and disappointing nights of my life. I had nightmares for weeks and battled with a little bit of post-partum situational depression and trauma that was accentuated by our recovery and breastfeeding difficulties.

I had a lot of lingering doubts and unanswered questions about my birth experience. The paperwork from the hospital just said that the reasons for my c-section were FTP ("failure to progress"), FTD ("failure to descend"), and CPD (cephalopelvic disproportion..."when a baby's head or body is too large to fit through the mother’s pelvis.") I will have to be honest in saying that this had never in six months "set right" with me. I couldn't believe that my baby was just "too big" to birth, as I have known many women who birthed a lot of bigger babies. The “what ifs” were enough to drive me crazy at times. (What if I hadn't had pitocin? What if I had gotten an epidural? What if I had been able to have a little bit more time? Was there anything else we could have tried that we didn't?) I didn't understand what caused the fetal distress BEFORE I was on the pitocin, and why my body, which was made to give birth, wouldn't progress further than it did.

As I was writing out my birth story, I sent a "draft" to my midwife along with some of these questions. A response with the words "oblique right occiput posterior position" opened up a new chapter in my birth story and gave me a clarity and a peace that I haven't had since the night Ezra was born. I could probably fill up another whole post with the causes, symptoms, and ramifications of my baby's fetal position, but I will try to summarize and put this in as plain English as I can: Basically, it wasn't that Ezra was too big, or that I was too small. Rather, it was the position of the baby in relation to my pelvis that was problematic! Based on my symptoms both in the weeks leading up to my birth as well as my symptoms during birth, I believe that Ezra was actually malpositioned for weeks. While it's possible that with prior knowledge of this this fact, along with more exercise, a better diet (less weight gain), and a variety of other techniques and practices during my pregnancy, this MAY have been avoidable, I was unaware of his position. By the time labor occurred there wasn't much that could be done besides what we already did. Further research into the subject of malpositions during labor (please read this link if you are pregnant or just want to know more about it) has made me realize even more what an excellent job my midwife did in positioning my body during labor in attempt to fix the malposition, though I was unaware what was going on. Additional factors such as the early breaking of my water (which was unavoidable at the time), the shape of my pelvis, and the fact that the bones of Ezra's skull never collapsed to allow for more descent contributed to the need for a c-section.

Up til this afternoon, while I trusted my midwife and I knew in my head that there was indeed a reason for my c-section, I was having a lot of doubts and a really hard time believing that it was necessary. Now, I understand completely, and have complete peace about what happened. I can say with confidence that, not having a knowledge of and understanding about the malposition at the time, I did everything I could to birth Ezra as naturally as possible. I sat there this afternoon and just cried and cried sweet tears of relief, self-forgiveness, peace, and, for the first time, full acceptance of my birth experience.

I am so thankful for my midwife Mary. She was AMAZING! She advocated for me at every turn, fought against the hospital staff, kept my husband calm, remained balanced and honest in presenting me options, was there to welcome my baby into the world, and stayed with me to help me start nursing, even though Ezra was her 2nd birth in 24 hours. I know that she was running on sheer exhaustion, yet still she put my needs first. She has, since then, remained available for support and helping me through this, even through these emails that we exchanged today! She has also since left her hospital job and is attempting to fight the legal system and open a free-standing natural birth center in our town. (Please pray for her in her endeavors.)

Going through a c-section has really opened my eyes to pride in my heart and given me a compassion for those with similar birth, recovery, and breastfeeding experiences. I know that prior to Ezra's birth, I was very quick to (internally) judge others, pinpointing what birth interventions caused their c-sections or difficulties birthing...passing off their difficulties as “unnecessary c-sections” resulting from a lack of education. Now, I know that things are not always as they seem. Sometimes c-sections are necessary.

As far as my stance on natural birth, it remains the same. I still believe it is best for mom and baby...I do daily reading on the subject to include birth stories ranging homebirth to VBACs in hospitals. I will be doing everything in my power to have a VBAC and am praying even now that God provides us with a wonderful midwife, doula, and birth center wherever we are located when the time comes. Even the research I did today on fetal positioning has given me another boost of hope that it wasn't my body that failed me, it was simply a less-than-favorable situation that may or may not have been avoidable. The next birth doesn't have to be the same way!

Above all, though, I am thankful. While I don't believe that “a healthy baby is all that matters in the end,” I daily choose to let the healthy baby be the only thing that I focus on. I am a mother, I love my baby, and nothing about my birth experience changes that.

I will end with an excerpt from another blog post:

But can we please stop, for one moment and recognize, that no matter how educated or uneducated, coerced or informed the choice that woman on the operating table made or didn't make, whether that cesarean was elective or emergency, necessary or unnecessary - it takes a lot of courage to get there. Our birth culture may be saturated in fear-based decisions, but behind every cesarean and "unnecesarean" is a woman of courage. In that moment, it doesn't matter how that woman got to the operating table. It doesn't matter if the surgery is necessary or unnecessary, what matters is that it takes extraordinary courage to say:

"Cut me open.

I love my baby so much, that I will do anything to get my baby out of my body alive.

Lay me out, cut me open

because I love my baby so much."

That is courage. That is bravery and sacrifice and mothering in its purest form. That is the willingness to lay down your body and risk your life that your child might be born, that your child might live.

Cesarean mothers are BRAVE.

(http://avital.blogspot.com/2011/01/cesarean-courage.html#ixzz1F88LDxxZ)

(quote by Barbara Katz-Rothman)