Wednesday, February 29, 2012

I am Able by Miranda

My orb is gone and the milk is in; I have to start writing this story before it leaves me. My partner Al and I had the blessing of a home VBAC. To tell the tale, I start with my first birth:
Our son, Lev, was born in a hospital by c-section. It was a birth that confused me, one I will never completely understand. I walked towards it with too much Ina May in my heart, too many easy birth stories nearby. More, we were living in Rhode Island where the C- section rate is of the highest in the country. We didn’t have the finances or medical support to consider a home birth.
For prenatal care we had a great but overworked midwife, Mary. Then, during one of our prenatal visits, we saw Mary’s intern, an MD named Rowena. Rowena was squeaky and new. She wore knee-high spike-heeled boots and had long fingernails. During the one visit I had with her she told me I had to take my glucose test though I resisted (I ended up failing the test). During this visit Rowena also explained she was a family practice MD looking to broaden her experience. She said she was focusing on C-sections, which she (and I quote) “loved to do”. I was grossed out.
My water broke on it’s own near the due date. I soon reached strong, steady contractions. We called Mary and didn’t think too much about it when we learned Rowena was the one on call. We were just excited about what was ahead. We raced to the hospital and then, slowly, over the course of the next night and day, moved downhill.
While I labored with Al, a doula and a best friend, Rowena waited outside the door. She was trying to give us space but there was not trust between us. I could feel it. She was waiting to tell me ‘no’ just as she had with the sugar test. I wanted to lock the hospital door. I wanted the midwife Mary to show up.
I reached dilatation after 15 hours but retained a cervix lip. Then my contractions began to die down. Another several hours later, I was put on pitocin. Finally I was asked to push. I don’t remember having a sense that I wanted to push. My head was blurry by this point, now 24 hours of hard labor later. I pushed for hours. I felt lost. I forgot what I was doing. I wanted everything to end, everything to stop.
Then Rowena entered the room and told me my time was up. She reminded me that I ‘failed my glucose test’ and asserted that there was a hospital policy allowing one to labor only up to 24 hours after the breaking of the waters. She doesn’t even say the word “c-section”. It had been hanging in the air for hours now.
I was so fragile at that point I ask to be anesthetized entirely for the operation. Luckily a smart doc talked me out of it and I was steered into the operating room where I was given an epidural and morphine. Things then felt soft, warm and far away. My son was born. Al sobbed because the birth ended so differently from what he knew I had wished for. Admittedly, Lev was big: 9 lbs, 6 oz.
Afterwards, Rowena came to my bedside to tell me she noticed I had really nice stomach muscles. I guess that’s what she was thinking when she stitched my abdomen back together.
Now, move forwards several years and across the country to a place with progressive birthing culture. When we got pregnant, I knew I had to at least try for an experience that was different from my first. No one in my family has had C-sections. I suspected I too could get a baby out the old fashioned way. I just needed to have the space to try. I couldn’t deal with entering a hospital and immediately being categorized as high risk. I knew it would help if there weren’t an anxious doctor watching numbers and waiting to tell me my time was up.
We were pointed to Maria because she is brave enough to do homebirth VBACs. We knew Maria was the right person immediately. She felt grounded, not full of hocus-pocus or anger but full of love and wisdom.  Trust formed between us. Meeting with her for hour-long visits (!!!!) was beautiful. Both Al and I felt listened to and unrushed. I’ve told every doctor friend I have that this kind of relationship gives me hope for medicine. A human connection is so powerful and so undervalued.
Maria felt that trying to lower the birth weight through diet control was one way we could affect things. Though I had passed my sugar tests with Baby #2, we chose to operate as though I had gestational diabetes. I started watching my diet closely and walking for 45 minutes daily.
Cutting back on sugar was not fun. In general, I’m proud of how I eat. And here I was, at the hungriest moment of my life, limiting foods I think of as healthy (organic farmers’ market strawberries, for example). I held back on breads, grains, fats (esp. milk fats), maple syrup, honey, fruit, yogurt, even tried to not eat too much protein. I wasn’t having beer, juice, milk. I basically moved from celery stick to chicken breast to peanut butter and always felt unsatisfied. But it was what I could do every day that made me feel like I was moving towards a beautiful birth.
As our due date neared, the tension of people around me grew. Family, friends, even strangers offered their opinion on the dangers of a homebirth VBAC. In response, I imagined myself as a mean lion. I watched to whom I spoke. I stopped telling people that we were planning a homebirth. I answered the phone only if it was someone who gave me strength, asked Al to screen calls. I made our home, where the birth would be, a protected space.
Interestingly, as my pregnancy progressed, I also realized I was at peace with the possibility of a second C-section. I didn’t hope for it but I didn’t clench against it. I let myself be open in everyway.
I spent time imagining a successful birth. I imagined the baby’s body squeezing through my own body. I imagined the sensation of him coming out of me. I watched videos of water homebirths on Youtube almost every other night during the last few weeks. I put positive imagery throughout the house (fresh flowers that were opening). I wore hoop earrings that symbolize my opening cervix.  I thought about myself “opening” for weeks beforehand.
I knew the burden of making birth work was on my shoulders. I was so lucky to have the support of Al and Maria, of course! But in the end, I had to do the work. I had to be brave and extra strong. It would have been fine if we’d transferred to the hospital but if I wanted my homebirth, I had to make it happen.
Labor started in the darkness of morning. Quietly, I wrapped myself in a soft flannel sheet. I cooked myself some French toast (and ladled on the maple syrup). Lev and Al slept. I breathed and visualized opening. I crawled back into bed and took small naps between contractions. Four hours pass. It was then daylight. I felt calm and brave and knew it was time to call Maria.
When Maria got to the house, I could still focus enough to “think my body open” during contractions, something very different from my first labor with Lev when contractions were a frightening, clenching moment, a moment when I had no control. Maria checked me. I was 7 cm. I didn’t get excited. It would be hours more. Even days. “Open”, I thought to myself. Sue, the second midwife, arrived. I loved both of them and felt so happy they were near.
Then I was in the bath, Al squeezing my hips, when I started to feel rectal pressure. I wanted to throw up. The bag of waters broke. I saw seaweed in the bath water. Maria thought I’d pooped. I knew I hadn’t (it turned out to be muconium). Uncertain, Maria moved me to the bed. I start to push. It was not what I thought pushing would be. It didn’t feel particularly obvious.
I pushed while Al held me. Sue placed a cool cloth against my forehead. Maria said, “One or two more and the head is out”. I didn’t believe it would be that soon. I looked Maria and Sue in the eyes. I felt Al behind me.
I trusted all of them. I knew it could be hours more so I continued then suddenly the incredible pressure released. A buttercream covered baby was in my arms!
In reflection, Abel’s home birth was shockingly different from Lev’s C-section. For Lev’s birth, I was surrounded by charts, monitors, numbers, clocks, strange faces pouring in, calculating, waiting to tell me my time was up.
At Abel’s birth I was surrounded by my life partner, my own soft sheets, my blue bedroom walls and quiet, powerful midwives. I was present when Abel came out of my body. I was wide awake. I saw it happen. I play the whole event over and over in my mind now, almost in disbelief. It gives me a rush of happiness to know I am able.

Thursday, February 16, 2012

Lars Arrives--Face First by Melissa

 I used to think that if I ever had a baby, I would do it the safest way possible, which I thought would be a Cesarean.  I worked with doctors and several OB/GYN physicians who said that was the safest way to deliver.  However, several of my close girlfriends had difficult deliveries where they were induced, given Pitocin, endured difficult labors (because of the drugs) for between 14 – 36 hours and then were told they had to have Cesareans to deliver their children.  When these strong women, who I have great respect for, talked about their negative experiences during and after their Cesareans, I listened.  After I did more research I became wary of surgery and typical medical interventions that are prevalent during modern American hospital deliveries.  I learned of the risks of Cesareans and the benefits (for mother and child) of a vaginal birth.
When Sean and I found out we were pregnant, we decided to try for a homebirth.   We really wanted to avoid the hospital and I wanted to avoid the fate of my friends who were induced, had difficult labors, and then ultimately had to have Cesareans. 
I loved being pregnant.  I felt great and didn’t have any morning sickness.  The more we worked with Maria and took the homebirth classes with Jane Austin, the more excited and determined we were to have our baby at home. 
            When I got pregnant, I cut processed sugars out of my diet to avoid gaining unnecessary weight and to help save room for nutritious calories for the baby.  Nevertheless, I was diagnosed with gestational diabetes.  When I was diagnosed, I was devastated.  It can lead to Type II diabetes for the mother, diabetes for the child and other health concerns.  Moreover, gestational diabetes, if not controlled, can cause excessive birth weights and preterm labor.  Some people with gestational diabetes are able to control their blood sugars with diet and exercise.  If they can’t, they have to take insulin.  If I had to take insulin, Maria said it would not be safe to have the baby at home.
            When I went to UCSF to get prescriptions for a blood monitor and find out about managing the gestational diabetes, they said that patients with gestational diabetes under their care are induced at 36 weeks to avoid complications from diabetes.  (They also said they recommended induction at 37 weeks for “older” mothers [which I am because I am over 35].)  They said I had a 50% chance of being able to manage the diabetes with exercise and diet alone.  I was really concerned the diabetes would end up causing me to lose the chance to have a home birth and that I would end up being induced (and then maybe having to have a Cesarean) which I was trying to avoid.  Maria was optimistic, encouraging us to be vigilant and overcome gestational diabetes through diet and exercise.
            With lots of hard work on my diet (eating the right foods at the right time and monitoring my blood sugars 4 times a day) and lots of exercise (often 2 times a day), we were able to keep the diabetes under control.  Sean helped by making sure we cooked the right foods and took me out every night for our evening walk, up and down the hills in our neighborhood, even when I felt like I was too tired.  In a weird way, the gestational diabetes was a blessing.  I always made time for the gym, a swim, and did Pilates 3 – 4 times a week.  Even when I was busy at work, I took time out for a snack.  The end result is that I ended up losing weight and was in great shape during the entire pregnancy.
            Our due date was June 24.  Maria asked if we wanted to take castor oil to celebrate our due date.  Sean was ready and wanted me to take the oil.  I didn’t feel ready or that it was time.  I wanted our son to be born when he was ready.  I wanted to wait until I was closer to two weeks past due to try castor oil.
When that day passed, we started taking even more hilly walks, eating spicy foods, acupuncture and all of the other things we could do to get things started for labor. 
When I was a week late, Maria had me go in to UCSF for a non-stress test.  I went in on a Saturday, June 2 at 3pm for the test.  They told me it would take about a half an hour.  After almost three hours hooked up the machines, Judith Bishop, the midwife at UCSF came in and told me that not only did we fail the non-stress test, but that our son’s heart rate had two significant dips during the monitoring.  They wanted me to check into the hospital to be induced that evening because of the heart dips.  I called Maria who agreed.  She said that if the baby’s heart rate was dipping when I was sitting calmly being monitored, it could be worse during the stress of labor.  She said it would not be safe to go forward with a homebirth and agreed I should check into the hospital to be induced.
            They told me to go home and get what I needed and come back to the hospital in a couple of hours.  My cervix was ripe, but not dilated.  They said they would put Cervadil on my cervix which would likely cause my cervix to open to 2 cm over 12 hours.  Then, depending on how I was doing and how the baby’s heart rate was doing, I might be able to go home and walk to induce labor or they would use Pitocin.  There was also a chance the Cervadil would cause me to go into labor.
            We were not ready to go to the hospital.  We were absolutely prepared to have the baby at home.  We had set up the birth tub, ordered the supplies, put a waterproof sheet on the bed, prepared candles and essential oils for labor, had snacks for us and the midwives, etc. . . .  I had the house filled with flowers to enjoy when we welcomed our son into the world.  We had no idea what to take, what to wear, or who would feed our cats.  All we knew is we needed to leave for the hospital in an hour.
            When we got to the hospital, they insisted on putting in an IV per protocol in case they needed to administer medications later.  The nurse blew-out the veins in my arms twice.  They called an anesthesiologist who blew-out two more.  They ended up putting the IV in on the top of my hand which prevented me from flexing my wrist.  Judith, the UCSF midwife, put in the Cervadil around 10 pm and told me she would see me in the morning.  She said I might feel some heavy cramping as the Cervadil started to work. She said it was important that we got as much sleep as possible since I would probably go into labor the next day and we would need the energy.  We called Maria who said she would check in with us in the morning.
            It was hard to sleep, they had a monitor strapped around my belly, the IV was uncomfortable and the sound of the equipment was loud.  They kept coming into the room to adjust the monitor.  At about 1 a.m. they came in and told me they needed to give me fluids through the IV because the baby’s heart rate kept having periods where it dropped.  A little later they came in again and had me put an oxygen mask around my mouth to attempt to keep the baby’s heart rate up.  Needless to say it was impossible to get any rest with all of the equipment attached to me and dealing with the fact we were in the hospital instead of at home.
            Around 2:30 or 3 in the morning, I started to feel pain similar to period cramps and I needed to go to the bathroom.  However, I had to have them come help me move the monitor and IV drip onto a rolling rack so I could walk to the bathroom.  By 4:30, I was parked on the toilet, the fluids from the IV made me urinate and I kept having to release my bowels.  I started feeling very strong pains, like a really strong period.  I thought I was being a wimp . . . how did I think I could have a baby at home when I couldn’t even handle the pain of my cervix being dilated 2 cm?  I didn’t want to wake up Sean since we both needed rest for the next day.  
            I kept having to go to the bathroom.  A nurse came to re-adjust the monitor on my belly and I asked her if the wetness on my pants could be my water that broke.  (I didn’t know because I was going to the bathroom so much.)  She looked at me funny, said she didn’t know, and left.  (I later found out it was a crazy night on the hall . . . they delivered 8 babies between midnight and 8 am that night.)
            By about 5:30 I woke up Sean.  When he asked what he could do, I said nothing because I thought was just having strong urges to go to the bathroom.  I didn’t think I was having contractions because there wasn’t a real break or change in the pain.  There was nothing to time because there wasn’t a surge – it was steady pain and cramping.   All I wanted to do was get on my hands and knees to practice the breathing we learned in Jane’s class.  I couldn’t get to the bed to get on my hands and knees because by the time I would get there (dragging the pole with all of the cords for the monitor for the baby and the IV), I would have to go to the bathroom.  I wasn’t comfortable on the floor of the hospital (which we dragged a sheet onto) because of the IV in my hand made it painful to flex my wrist, the floor was hard and it felt so foreign.
            Sean kept saying we needed to call Maria but I didn’t want to call her until I went into labor.  At that point I was in extreme pain and couldn’t think straight . . . I also couldn’t get off the toilet.  Thankfully Sean went ahead and called Maria and asked her to come.  He also went and found a nurse.  It was about 8 am and the day shift nurse came in.  She asked me if I wanted her to have the UCSF midwife come in and check me.  I told her no because I thought it would be pointless since I was probably only 2 cm dilated.  She recommended I take a bath to get more comfortable.  When I got in the bath, I couldn’t stop pushing, I realized my desperate urges to go to the bathroom had turned into urges to push the baby out.  I was concerned because I knew that we shouldn’t start pushing until I was 10 cm dilated.  Writhing in pain, I jumped out of the tub and I asked the nurse to call the midwife.
            Judith (the UCSF midwife) came in and checked my cervix at about 8:15.  She looked concerned . . . she said I was fully dilated (10 cm) but that she was feeling body parts that she could not identify.  She said she needed do an ultrasound and call the lead doctor.  At that point I was in incredible pain – and I finally understood why I was feeling so much pain – my baby had fully transitioned and it was happening so quickly.  The urge to push was constant and intense.  I couldn’t sit still for them to put the ultrasound wand on me.  When Dr. Cheng came in and said she wanted to check my cervix, I said no.  I was in so much pain and having someone’s hand inside of me made it worse.  I couldn’t stop screaming the contractions were so strong and there was only a few seconds in between them.  They had me inhale nitrous gas so she could conduct the exam.  I couldn’t feel the nitrous.
            Dr. Cheng said that the baby was coming out face first (instead of leading with the top of his head).  She said she didn’t think the baby could come out vaginally.  She said we could try but she thought they would need to perform a Cesarean and that they needed to transfer me to the operating room.  The contractions were coming so strong and so fast I couldn’t do anything but agree.  They had Sean put on a white paper cover over his clothes, shoes, head and face and they wheeled me on the bed, while I was screaming like an animal, into the OR.  Sean said Maria was on her way.  I was in pain and so frustrated because I thought I was going to have to deal with the recovery from a vaginal birth and a Cesarean (what I was trying to avoid from the start.)  As they were wheeling me into the OR, the doctor told Sean they would probably have to do a Cesarean.
            They transferred me to a narrow stainless steel table in the OR on my back.  It was so different from the soft carpet and warm tub I had planned for labor.  It felt like the contractions were non-stop and very violent.  I was trying not to push because they wanted me to wait and it was impossible not to.  They put in an epidural which slowed down the contractions and Maria arrived.  She came right up to me and whispered in my ear “you can do this, when you get a contraction, push!” 
            Dr. Cheng and Judith had never delivered a face presentation baby vaginally and were not sure it would be possible.  Face presentations are very rare – according to Ina May Gaskin’s book they occur once approximately every 500 births.  When Maria came in, she said the baby’s lips were exposed outside my vagina.  They were planning on somehow pulling him back through the birth canal to get him out by Cesarean.  Maria had one of the nurses she knew reach in and feel where the baby’s nose was.  (If the nose was on the side of my lips towards the upper part of my vagina, a Cesarean would be necessary to get the baby out.)  The nurse said his nose was on the side of my lips near my anus.  Maria got a big smile on her face and then told Dr. Cheng and Judith the baby could come out vaginally.  She encouraged them saying “Melissa can totally do this . . .  I have delivered three other face presentation babies vaginally . . . it is totally possible and Melissa is really strong.”  It was amazing to observe Maria convincing these other medical professionals to let me try to deliver him vaginally.  She reminded me of a naughty school girl getting other kids to hop a fence during recess. Dr. Cheng agreed to let me try to deliver him vaginally.

Here is a picture of his lips sticking outside my vagina.

            I pushed through approximately seven strong contractions.   Maria and Sean were on one side of me and Judith was on the other.  There so many people in OR but I focused on Maria and Sean.  It is strange but I really felt the calm strength of being sandwiched between two midwives (Maria and Judith).  Dr. Cheng kept urging me to push hard to get him out because his heart rate kept dipping and his face was obviously distressed (as evidenced by the picture of his face coming out below.)  I made it through looking into Sean and Maria’s eyes – they both kept telling me I could do it.  After pushing through about seven contractions and with the help of an episiotomy our son, Lars, was born at 9:15 a.m. 
            Here are the amazing pictures of Lars coming out. 

            He came out and heard his body slip onto the table.  He had an APGAR of 3, he wasn’t breathing because of swelling in his neck (his face and neck endured the entire trauma a baby’s head usually takes when it traveled through the birth canal).  The physicians quickly took him out of the OR to the Neonatal Intensive Care Unit.  Within 5 minutes he had an APGAR of 7.  He was breathing but his face was still very swollen.  After a few hours most of the swelling had gone down.  It was almost completely gone by the next day as evidenced by the picture below.

            We were able to come home after four days.  Maria came to see us in the hospital and provided follow up care at home.  It was great to experience some of the home birth practice when Maria would come to weigh Lars and check in with us. 

            Another good thing was that Lars only weighed 6 pounds and 5 ounces, hardly a large baby.   All of our hard work controlling the gestational diabetes paid off.
            Even though Lars’ birth didn’t happen as planned, I am so grateful for the care and emotional support Maria provided our family before, during, and after Lars’ birth.  For me – Maria saved the day.  I was able to avoid what I feared most about the birth process – that I would have to recover from the pain of a vaginal birth and that of a Cesarean.