Thursday, May 5, 2011

Maia's Blessed Birth Or: How I had a Homebirth at Kaiser

by G.B.

My family is together in our bedroom on the second daybreak of our daughter’s life.  Daddy is holding Maia in bed, and Cindy Lou is looking on at the strange scene from her doggie bed in the corner.  And I am in awe of the many blessings we have received as we brought Maia into this world.  I don’t want to forget a thing about her birth.
After the birth, our midwife Maria said eloquently, “In a hospital, they are focused on a healthy baby and a healthy mama.  And we midwives are focused on that, too, but we add healthy process.  Because most of the time, without a healthy process, you don’t have a healthy baby or a healthy mama.” 
          Our process began on Sunday, April 17.  Brian and I spent the day quietly together.  Things had been feeling hectic and separate and impatient for me.  I felt like the baby might be coming soon, but I needed to connect.  We went on an urban hike, letting the location of bakeries determine our route.  We walked a hilly course of about 6 miles around the city, stopping at bakeries along the way.  Sesame tofu salad at Mission Pie, vanilla wafers at Dianda’s, a strawberry tartlet at Destination Bakery in Glen Park, a chocolate chip cookie at Noe Valley bakery, and then back home to Sharon Street.  I was totally exhausted, but not feeling any closer to labor.  I went to bed with the same feeling I’d had for a couple of weeks: ”Maybe tonight…?” 
          That night, at 3am, I woke up from what felt like regular surges, but I let Brian sleep.  A note about “contractions.”  I wasn’t sure what I was feeling, since the sensation was similar to the menstrual cramp achiness that I’d been having for weeks.  And really, the contractions I experienced during labor, whether light or profoundly deep, were more like surges of energy.  I know the biological explanation of contractions, but to me it was a life force surge.  I wish I could say that this helped to ground me or center me during my labor.  It did not.  It’s more in retrospect that I understand my experience of surges.
Around 4am I decided to do some timing, and sure enough these surges were about 10 minutes apart and lasted 30 seconds each.  Brian’s alarm rang at 6am, and I let him know that we were going to have our baby soon.  I was incredibly excited and curious.
          We decided to keep our 8am appointment with our midwife Maria rather than call her.  I must explain about Maria.  The more we have learned and experienced about pregnancy, birth, and babies, the more in awe I become at Maria’s incredible depth of knowledge and skill in caring for mamas and babies in a deeply caring, spiritual, and individualized way.  She took incredibly good care of my family, but more to come on that subject.
To get to Maria’s office, we took the J-Church muni train.  I had a couple of surges on the train, but was able to breathe through them and sway my hips in the seat.  When we arrived I excitedly announced that I was in labor.  She checked my vitals and sent us home, advising us to go about our business and have a regular day, though I couldn’t imagine how to do that.  I was really excited about being in labor, and I was so curious to find out what would come next.  We went to a café, stopped by a market for some supplies, and instead of waiting for the train home, we walked the quick mile through a foggy Dolores Park.  Things felt perfect.
          My mom came over to our house at around 10:00, and we decided that she and Brian were going to take Cindy Lou out for a walk while I rested.  Just before they left, I had a surge, so I stood up and leaned over on the table, and, Pop!, my water broke.  The sound and sensation of the pop were so surprising that I yelped and cracked up.  I could not stop laughing, which of course pushed out more liquid, which made me laugh harder.  Brian and Mom decided to skip the walk.  I was having a great time!  I called a dear friend in Virginia, and was still able to talk reasonably through my contractions.  I sent a few text messages about my water breaking, and got some encouraging responses back.  This was really happening.  My baby would be born on Monday April 18th—full moon, foggy San Francisco, Passover—perfect. 
          Around noon, the surges intensified and I had to move and moan through them.  The work was starting.  Brian stood by me and helped me through each one as we moved through the house.  We worked on the exercise ball next to the bed, on the toilet, over the couch.  Brian timed the contractions, and while it was clear they were building, I knew we weren’t anywhere near the 4-1-1 mark: contractions 4 minutes apart, one minute duration, for at least an hour.  My mom and Brian were really eager to contact Maria, so at 1pm Brian called to give her an update and let her know that my water broke.  She was excited and encouraged us to keep going and call her back when we reached the 4-1-1 mark. 
My surges built to about 3 minutes apart, but were a bit inconsistent, as occasionally I’d have a 5 or 6-minute interval.  They were also short at 35-45 seconds.  They were, however, consistently strong: I had to moan and move through them.  I got impatient around 5 or 6, and at 6:30pm (still Monday) Brian called Maria to report our progress.  Even though we hadn’t gotten to 4-1-1, she decided to come over. 
I was relieved when Maria arrived at about 7pm, because I felt like I’d been working hard to get labor moving by trying all sorts of positions, movements and moaning.  I was getting tired and I was curious to know how dilated I was, and how close I was to having our baby!  She checked me, and we learned that I was 3 ½ centimeters dilated.  This was pretty discouraging to me, and was definitely a low moment.  I’d felt so prepared for many things, but I didn’t know anything about bringing labor on.  I’d just assumed it would happen naturally.  I was tired and out of ideas.  We all needed a break.  Brian’s parents brought food over, and my mom and Brian ate while Maria set up.  I was not at all interested in eating, although I was hungry.  I managed to eat a banana. 
The night is a bit of a blur.  It was a long night, but we continued to try everything: positions, walking, bouncing, swaying, atmosphere (music, candles), herbal drinks, and homeopathic remedies.  I called on my many mantras to help me: My body and my baby know what to do; My body is opening like a flower; KNOW; TRUST; and meditation techniques and yogic breathing and positions (juicy hips) to open, open, open.  I talked to my baby, and told him or her that it was time, it was ok to come.  I asked him or her what I needed to do. 
At about 3am, the 24 hour mark, Maria suggested I get in the tub for a change of pace.  My surges were very intense at this point, but the timing continued to be variable.  I was getting really tired, so the tub idea sounded great to me.  Being in the tub gave immediate relief to my tired, sore body.  Brian sat by and timed my contractions.  I was surprised by the power of the surges I had while in the tub.  They gripped my body, and I floated around to find positions and moans that would help move the energy through my body, and most importantly help the baby move down.  Some of these surges were long: about a minute and a half or longer.  The energy gripping my body was unbearable to me, but I stayed in the tub because I thought that maybe these contractions would take me to the next level of labor.  Still, it was hard work, and I told Brian I didn’t know if I could do it.  I felt despair: fear, hunger, exhaustion, and no baby in sight.  When would this end?  Brian was encouraging and loving and he is the reason why I was able to keep going.
In the morning, 12 hours after my first internal exam, Maria wanted to check my dilation.  So, at about 7am on Tuesday, I was eager to see how much I progressed.  I was 5 cm dilated.  What???  All that work, all night long, and I had only opened 1 1/2cm?  What was happening here?  We talked a lot about what could be holding me back, and what I could do to progress in my labor.  But first, Maria suggested this would be a good time to take a break so that I could build my strength up to keep going.  This sounded great to me.  We found a place for me to rest in a rocking chair, because when I lay down in bed, the contractions were too intense for resting.  In the rocking chair, I was able to rest for about 3 hours.  My contractions were coming every 6-10 minutes, and they were between 30-40 seconds, and they felt strong.  I had to moan and move through them.  I also had to train myself to stay in the chair when they were done.  I had the urge to walk around, and especially to go to the bathroom, but I knew I didn’t actually need to go, and that giving in to the urge to move around would not give me rest.
The resting was extremely helpful, and I was ready to ramp things up.  Come on active labor, let’s move this baby!  We had exhausted all homeopathic and herbal remedies; they just didn’t seem to be working.  We had a new plan: castor oil!  I would use the laxative to contract my intestines in the hope that it would encourage my uterus.  Yes, this would work.  I took the castor oil, continued to rest, and waited for the oil to work its magic.
At some point close to lunchtime, Maria noticed that the baby’s heart rate was decelerating during contractions, which is normal during active labor.  But I was no where near active labor.  Baby heart rate decelerations during early labor are reason for concern.  The castor oil needed to work.
I’ve lost track of time, but maybe around 1pm the castor oil kicked in.  I was re-energized: I had rested and I felt like this would do the trick.  I got back into positions and tried new ones, but still no progress.  It was clear after all the castor oil moved through me that it did not do the trick.  I still felt it was possible for these contractions to build to active labor, so when Maria suggested acupuncture, I was very excited because I knew my body responds well to acupuncture treatments.  We quickly found an acupuncturist, Linda, who was able to see me in 45 minutes, at 3:15.  At 36 hours of labor, we piled into Maria’s car and drove a mile down Church Street to see Linda.  Before we got there, Maria asked, “What do you think?”  I replied, “I think I’m going to get this treatment, it’s going to put me into active labor, and we’re going to have a baby by the end of the day.”  I was still smiling.
The drive was bizarre: I felt like I was watching a movie, or watching someone else’s dream.  The block and a half walk from the car to the office felt long, and I had a contraction along the way.  Linda treated me as I sat on a stool and was face-down on a large pile of pillows.  The treatment had an immediate effect, and it was not only due to the cupping and needles.  Linda encouraged me to call on my guides, to talk to my baby, and she asked what was blocking me.  I thought for a long while, and I said that I thought that the baby needed my permission.  When she asked me what I meant, I said I didn’t know.  Brian was in the room and he said, Yes, the baby needs my permission too!  It was deeply emotional, and I literally felt the baby move down as some of this emotional energy was cleared.  Linda and Maria left me and Brian alone together in the room.  I was still being treated, but Brian and I talked to each other and our baby, and made a plan for when we got back to the house.
I haven’t written many details about Brian’s involvement, but he was right next to me every second of this process.  He waited for my cues, he rubbed, pushed, pressed, and supported my body, or when I decided I did NOT want that, he stopped.  He whispered encouraging, loving words, and he timed my contractions while supporting me through them.  When we returned from the acupuncturist, with me deeper in contractions, we went into the “labor cave” (our bedroom), and sat together.  There were new rules: I did not want to hear any chatting in the house, and Brian and I would not chat.  We would sit in meditation, and I would do everything I could think of to progress labor.  The acupuncture moved the baby and deepened the surges, and I believed that focusing more on the labor would get us to the active labor part.
Brian timed my contractions in the cave.  Over an hour or so, there was no change.  Maria continued to check the baby’s heart rate during these contractions.  The deceleration was still there.  No change in either baby or mama.  Maria did an internal exam around 5:30.  I had been laboring for about 38 hours, and she told me that I was 5 ½ cm dilated.  I knew what was coming.  It was time to consider transport to the hospital.
Oh, the deepness of the disappointment I felt at this moment.  How could this be happening?  What was wrong with me?  What was wrong with my body, with my baby?  What else could I do?  I did not want to transport, but I know that if I stayed at home, there was the real possibility that my labor would not progress quickly enough and we would put the baby in danger, not to mention the fact that I was so exhausted that if I labored for another whole night, I might not have the energy to push at the end.
I turned to Brian.  He was so strong.  We talked about the cards exercise from our childbirth class.  We’d had 6 cards, and on each card we wrote a wish for our birth.  On the back of each card, we wrote the opposite of that wish, for example: short, productive labor on one side had long, slow labor written on the back.   Our instructor Jane had us lay them out, and one by one, we chose a card to turn over.  It was a very useful exercise in which we had to ask ourselves which aspects of our birth were we willing to give up, and what might happen if we had to give them up?  It was clear that it was time to turn over the have birth at home card so that we wouldn’t have to compromise the others, especially healthy mama, healthy baby
Tears came, certainly, but I felt that this decision was just the next step on our journey together.  The three of us, and my mom as silent backup, had worked together to consider each step of my labor.  I felt very confident with the plan: we were going to Kaiser to get, as Maria put it, “a whiff of pitocin” (labor-inducing drug), have the baby, and then get out of there AMA (against medical advice).  It was just the next step in my homebirth.
Upon arrival at Kaiser’s labor & delivery floor, Maria found a nurse who is her client!  She was going off duty at that time, but she set up with a nurse, Juliana, who was very respectful of my priorities and preferences.  Juliana was on our team, and was incredibly patient, kind and encouraging.  Perhaps most important, she communicated with the rest of the staff my preferences, and reminded them often how I wanted it done.
As I was getting set up, I looked at Maria and laughed.  What else could I do but give in and laugh?  I just couldn’t believe that after all we had done, all the months of thoughtful preparation and the hours and hours of labor, here I was in a beeping hospital room, surrounded by blue caps and masks, and hooked up to monitors and IVs.  But for some reason, I wasn’t sad, I wasn’t disappointed.  I guess I knew this was what it was going to take for me to meet my baby, and I was so ready.
Maria was right: all I need was a whiff of pitocin, administered at about 9pm, and I felt like I was pushing the baby out from the first contraction.  The OB had checked me upon arrival, and I was 6cm, but I felt like this baby was coming soon.  The surges were gripping, but it was a great feeling: finally, progress!  This baby was coming.  I didn’t have time to get used to this new level of contractions, and I felt a little confused by the rush.  My body was shocked and holding against the surges, but Maria reminded me to moan deep and low, and to relax my legs and bottom, which I kept gripping.  I knelt facing the back of the hospital bed, and as each contraction came, first I threw my hips against Brian, and then I figured out how to hold on to the back of the hospital bed and squat.  I felt like I was pushing at the end of my surges.  I heard Juliana say, that sounds like pushing!  I didn’t know if I should do that yet, but Maria told me to just go with whatever was happening, and Juliana was very encouraging and told me to “do my thing.” 
I know that I was in active labor for 3 hours, but it seemed about 40 minutes.  Towards the end the OB came in and shouted, “wait, wait you’re having a baby!”  I was too deep in labor to actually laugh at this, but I knew it was totally absurd.  She insisted that I labor on my back: what a vision!  I was confused at this point, not having my wits about me to protest.  Maria helped get me into a position, and I started pushing.  WOW, the incredible power that I felt.  It was amazing.  This baby was coming.  But still, that laughter in the back of my head: was I really lying down on my back with a bunch of OBs in scrubs yelling “Push, PUSH!?”  Yes, that is how the last few minutes of my homebirth went.  And suddenly, I looked down, and there was my baby’s beautiful, perfect head, screaming.  What an incredible sight.  I continued to push, and just a few minutes later my husband placed our baby on my chest, and let me know that we had a girl. 
I am unable to describe the bliss, gratitude, and wonder that filled those moments.  I was aware of some activity around me, but mostly it was just me and my baby, my husband Brian elated by my side.  In the next moment, I looked at Maria, and her face had the same look of excitement that I felt.  It was like were we silently saying to each other, what an awesome birth!
And so, Maia Ambry Cavagnolo was born at a Kaiser homebirth at 12:14am on Wednesday, April 20, 2011. 
Healthy mama, healthy baby, and I would add: very healthy process.

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