The Birth of Evan

  At 40 weeks, Maria said that the baby was still pretty high and recommended to walk. I started to climb Bernal Hill every day and it felt really good! She also recommended to go back to my Zumba classes, which I have been taking until 37 weeks... and she even came with me! :)

I was a bit surprised to reach 41 weeks, on March 22nd. My daughter was born on her exact due date, 3.5 years ago, and I guess I was expecting this baby boy to come out close to the guess time as well. My french due date was actually passed only 2 days ago, so I was then relying on this one. I went for a non-stress at the hospital (Kaiser) on that day and it went very well. An induction was scheduled for the following week.

I was having some mild cramping and had two false start at night during the last few days, so I was optimistic and staying confident that this "false" or "pre" labor was leading somewhere sometime soon - at least before the induction. I was tired though, as it was difficult to sleep through it. That evening, I asked Maria what I could do and she suggested to take a bath and have a glass of wine. That's what I did and the glass of wine was amazing! It took me some time to drink it but I was definitely feeling more relaxed and sleepy. I went to sleep around 11pm.

I woke up at 2:30am and I was having my first 'real' contractions. I felt some leaking so I had to wake up my husband to protect the mattress and the floor so I can stand up and go the bathroom without making a mess (in case my waters would break). I was not able to go back to sleep in between the contractions, and may have been afraid that they could go away if I was falling asleep! I was happy and hopeful to be in labor as I deeply wanted this homebirth. I knew it was real labor because they were not going away even though I was changing positions, eating, etc. I started to time them. At some point I went into the baby's room and labored in there, sending my husband back to sleep. I wanted everyone in the house (including my daughter and in laws) to sleep so I was very quiet.

Everybody started to wake up in the morning and I went back to bed around 8am. I was tired. I was waiting for the contractions to get into a regular and active pattern but this was not really happening. They were sometimes close together but short, some other time further apart but more intense, but I was not getting a 4-1-1 pattern yet. I first called my dear friend and birth doula, Ti, so she knows I was in labor and probably needing her on that day. She told me to call her back when I needed her to come. Then I called Maria, she asked me if I wanted her to come and I wanted to say YES but I knew it was still early and we agreed to stay in touch in the morning.

My daughter left with her grand parents to go to preschool. Maria said to start filling up the birth tub by the phone and Yann did that, but it was a bit more complicated than when we did it before labor started, 'to try it out'. I was getting tired to be on my own as my husband was busy with the tub so I called Ti and asked her to come. When she arrived she helped me to realize that I was still in early labor and that it could be long... which was so difficult to hear! She suggested to stop timing the contractions and focus so much on them, and to go for a walk. I'm glad she suggested that and I wanted to do it, but I was a bit scared to deal with the contractions in the outside world. We went out thinking we'd go one block away from the house. I had a few contractions and was able to manage them. So we decided to go on Cortland Street a few blocks away to the coffee shop. We stopped at the pizzeria because it was smelling good and I had a few bites of a slice, in between two contractions. Then we decided to go up the hill... which I have been doing every day for a week. I was hanging from houses' fences and my husband when I had contractions. I didn't really mind what people could think. I climbed some stairs at the top of the hill and we came back. It took us a long time! The weather was really nice.

When we were almost back home, I know I needed to go to the bathroom. Ti told me that a change could occur after I went to pee. I had a strong contraction on my outside stairs. And indeed, everything changed as soon as I went to the bathroom. Contractions began to be every 3 minutes and at least 1 minute long, there was a clear pattern change as they were stronger and closer apart. Everybody was trying to have a few bites of food in between contractions in the kitchen. We called Maria and asked her to come, she arrived less than 30 minutes later.

Maria checked me and I was 5 centimeters, exactly what I was thinking and hoping for! But she also said that my cervix was thin and soft and that I could dilate easily the next centimeters... I think this few words set up a new tone and direction in my labor. It took me 12 hours to dilate until 5cm, and only 4 hours more after that until the baby was born.

At this point I labored standing up and doing squats when I was having contractions, leaning on my husband or Ti. Ti was massaging me in the back and legs and it felt great. Then something strange and very pleasant happened. I felt like a hormone rush and very confident. The beginning of a contraction was painful, then I was working hard on relaxing my pelvis and cervix as much as I could, until reaching a point in physical relaxation that was making the pain disappear, making me feel so powerful and happy! I was laughing, in the middle of the contraction, kind of a laugh and cry at the same time, because it was so good!! I was working with my body, with my baby, and everything was in harmony. I was feeling the pressure and the baby coming down at each contraction.

I started to feel tired on my legs and moved into the bed. One contraction later I was feeling hot and cold, a bit dizzy and nauseous. I almost threw up but didn't (which was one of my fears, with tearing, though at the moment I was okay with it!). I thought I was in transition because it was exactly how I felt when I was in transition during the labor of my first child. Then I decided to lay down in the bed, on my side. I wanted to rest, but it took me a few contractions to feel okay dealing with the contractions in this position. I think Maria checked me again to see if it was a good time to go in the pool. I was 8-9 centimeters.

I went into the pool and it felt AMAZING! I didn't want to work anymore! I just wanted to relax and enjoy the sensations of being in the water... Contractions slowed down. Maria encouraged me to go back into a squat position, in the tub, and I was reluctant because I knew it would bring more pain and stronger contractions. It took me a little while but I did it and it definitely brought back strong contractions. Then Maria checked me again and I was fully dilated. She could feel the bag of waters and I asked to break it to facilitate the pushing phase... she managed doing it in the water with her fingers. I was getting impatient, and scared. It turns out this baby was bigger than my first one (8lb6oz over 7lb10oz) and I could feel stronger sensations/pressure while the baby was descending. I couldn't see the pushing phase coming. I was asking for help and getting a little bit dramatic... In retrospective I think it was my way to stay connected to my birth team, I needed them to know I was struggling and needed their support, and they all responded to it.

I couldn't feel the pressure and the urge to push in the tub as I probably could have felt it outside. Maria offered to go sit on the toilet and I didn't want to, I wanted to give birth to my baby in the water! I started pushing and I was feeling like I didn't know what I was doing. I was feeling unstable in the tub and asked my husband to come in so he can support me, which he did right away. Finally and very suddenly I felt the head coming and decided to get it out through the same contraction no matter what. I was crowning and asking what to do, my husband I think reminded me to do the horse lips like I told him to... I tried to breathe and relax my jaw which was so difficult... but it was fast and the head was out. I put my hands on his head and felt his hair. Another contraction and the rest of the body came out. My baby boy came on my chest and he looked perfect... He was covered of vernix and so soft! I loved his smell. The pushing phase lasted 23 minutes. My husband was crying, telling me that our son was beautiful.

I was loosing some blood so Maria wanted me out of the water pretty quickly, to know how much I was loosing. Maria clamped the cord and Yann cut it. The second midwife Sue took my baby while I was getting out of the tub to sit on a birthing stool, where I delivered the placenta. Sue gave me my baby back very quickly. I was helped to go in my bed after that. The bleeding stopped quickly and everything was okay. Baby was doing very well. I had 2 stitches first degree and Maria did a great job with it. It was the busiest time for the midwives who were making sure both of us were doing okay and very focused on what they had to do.
Before and after that, they were so relaxed and confident in what was happening! That was very reassuring to me and made me feel everything was normal, reminding me this was a joyful event. My boy latched on on both breasts and was sucking very actively for a while. After about one hour, my daughter came to meet the baby and this was a very strong and emotional moment to me.


A few reflections

Before wanting a homebirth, I wanted midwife care for this pregnancy. I wanted continuous care, choose/know the person who will be there when I give birth, and get some postpartum care (6 visits instead of 1 through the regular hospital care...). When I realized that midwife care was going along with homebirth, I started to think about it, get more information, go to Meet the Midwives at Natural Resources and watch homebirth videos on YouTube. I was already a few months pregnant. After meeting some midwives with my husband (and getting his support about doing it), it suddenly became obvious that it is what I wanted to do.

During the last 2-3 weeks of my pregnancy, I really needed to be surrounded by other women who had a homebirth or where also planning on having one. I needed to hear about their stories in details or share our plans/excitement/concerns when they were expecting too. I have two friends who had a successful homebirths and I wanted to hear again about their stories. I established quick and strong connections with some other women under the care of Maria as well, met through the group that she is facilitating in her office twice a month. At some point I couldn't hear about other people's questions or fears about our birth plans, even coming from close friends or family, I just needed to protect myself and feel part of a community who was sharing the same goals and birth philosophy.

I think women who plan on a homebirth are even more educated about the birth process. Watching many videos is part of the preparation, and I learned so much through them... Can the baby stay safely in the water when the head is out but not the rest of the body? What does the placenta looks like and what are the ways to birth it? What are the best pushing positions to avoid tearing? Also, a homebirth includes material preparation. My midwife gave me a full list of supplies to get ready and believe me, you learn a lot while figuring out why each item is asked for... You need to think about where and how you want to deliver in your home, find a bowl in your kitchen to receive your placenta, buy some plastic tarp to protect your floors and mattress, and so on! You are in charge of your own birth event.

I had a non-medicated birth at the hospital with my first. Although everything went accordingly to my birth plan without any complications, I needed to tell mybirth story as often as possible and probably provided more details than people wanted to hear :) I think I was a bit in shock, because of the intensity of it. It also lasted 30 hours + and I was exhausted at the end. Whatever is the reason, I do not feel the same about this birth. I feel much more at peace with it. I needed to ask a few questions to Maria and to Ti a few days after the birth, but that's about it. It don't feel able to relate the simplicity of the story. I feel like I'm sharing a secret with the people who were there. They know.

It looks like I was very suggestible during this birth. When Ti told me to expect a possible change when we came back home after the walk and going to pee, my contractions began suddenly much stronger and closer, Ti called Maria within 10 minutes after that. When Maria checked on me the first time, she said I was 5 cm and that my cervix was so thin and ready that I could dilate very fast if I wanted to - and it took me 'only' a few hours to be complete. When Maria told me that the head would be out a 'handful of contractions' later, I almost got angry at her because I didn't want her to give me false expectations or hope... but only one contraction later the head was out! I don't think these are coincidences. I think I had so much faith, love and respect for all the people around me that they were really able to influence me - my labor and my body. Considerably! Trusted people and familiar environment are invaluable.

Midwives are amazing. They know exactly what to do and what to say, at the exact right time, to help you get going, reassure you, or just help you to keep trusting your body. They are not necessarily talking or doing that much... but when you need them they are here! A few times during the pushing phase I screamed "Mariaaaaaaaaa, help me!' and she did. They have a very safe presence and never give you the feeling that they know better than you what is going on. They let you take the lead so you feel powerful and able to push this baby out.

Someone asked me if there were some disadvantages of giving birth at home. I would say:
- there is quite some work to do during the first few days after birth for the dad, in terms of cleaning up (doing laundry to wash the sheets and the towels), especially if it was a water birth, and you can't really wait and let this sit for a while ;)
- it is wise to make plans ahead for the first few days: since you are at home and more likely walking fine, people around (or yourself!) may start doing things on day one that nobody would expect you to do if you were in a hospital... it was almost like nothing happened and I realized it was wrong, I was not ready to go back to 'normal' life especially with a toddler around, so I forced myself to take the time to heal, recover, and enjoy those precious few days (but I wish I had envisioned it ahead of time)
- financially: since we are at Kaiser, we had to pay out of the pocket all costs (somewhere around $5000). We have no regrets at all, of course, but that's an aspect to consider.

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.   

           

Listening in

Marcello listens in during the pregnancy, then knows just what to do when his mom, Mia, is in labor. Children who are taught about birth are not afraid. They will welcome their siblings with joy and celebration.

Welcome Enzo Matthew,
born on May 31, 2008 to Mia and Matt
and big brother, Marcello!

Lola is Here!

Cozy has an amazing little sister!

Her name is Lola Davis Shoffstall and she weighs in at a hefty 8lbs 1oz, 21 inches long and has a 13 1/2in head. Oh and she has 10 fingers, 10 toes and a very cute little tongue. She hasn't asked for a pony yet, but she already asked for a new MacBook Pro!

She was born at 2:24 am on July 30th, 2007 at home with the help of our midwives Maria and Abigail, and their assistant Michelle. Christina was incredible, labor lasted for a good 26 hours and she is doing well resting with Lola right now.

-- Sean Shoffstall, brand new Dad