V's Birth Story Part 4 -- Delivery

Continued from Part 3: Labor Intensifies (or start at the beginning).

It was around 11:30 AM. Doula K and Doula J stepped out, as they were not allowed in the room while the anesthesiologist was there, per hospital policy. As it turns out, the anesthesiologist didn’t care if they were in there, but I let them stay away so they could grab some lunch. Realizing that I was selling out the vision of a med-free birth that I’d had since I was a teen, I started crying before the epidural was placed. The anesthesiologist was trying to be nice but made some sort of jerky comment about how lots of women think they can do it on their own and then he gets called in. It was so demeaning because in my heart, I felt this was a medically advantageous decision and not one that was about eliminating labor and delivery pain. I had made it through 50+ hours of labor without meds, a true ultra-marathon—triple the length of an average first-time mom’s labor—and now I was reduced in someone’s eyes to just another  compromising woman who couldn’t actually hack it. It felt like just lonely me against the world to the point that I still have no recollection of Dave being there (though he assures me he was).

After that team left, I worked toward getting in the side-laying position. Dr. M had said that even with the epidural it would be uncomfortable and most women could only manage a few minutes. I was resolved to make it work, no matter how long it took. We put on relaxation music, darkened the room, Dave and the doulas were quiet, and I focused on my breathing for as long as I could bear the pressure in my belly. I made it lying on my side for an hour, much longer than Dr. M had ever had a patient do before.

Dr. M checked baby and found that he had indeed moved, but he had moved occiput transverse, an even less desirable position. We tried the fluid and manual rotation of baby tactic, which was not successful. I think it was at this point that she discovered I had meconium staining. The presence of meconium didn’t stress me out, as we’d covered this as a normal variation in Bradley classes, but Dr. M again insisted that a c-section was undoubtedly the road ahead.

Yet, our little labor team kept plugging along. The environment looked very different than dreamed with me in bed with an epidural and constantly on the monitor, but it was dim, quiet, and relaxed, and eventually I reached full dilation. At some point in there, I was emotionally done and the pain was intense and for the first time I wanted pain relief for the sake of pain relief. I didn’t know that I could push the button to get more medicine, so I let the epidural wear down. By the time I brought it up to someone, it was too late to settle in for pushing.  So, they offered a shot of lidocaine. I’m guessing that was at transition, but I don’t really have much recollection of that time. Medical records also are of little help.

During the considerable unmedicated portion of labor, the records talk about my mood, how I managed pain, etc. The records share lots of “breathing well through contractions” comments and some notes about me being pleasant but refusing things. After the epidural, the records are completely impersonal—just numbers from a monitor and quantities of drugs. I could talk for hours about what this implies in terms of the overall medical model of birth versus midwifery care, but that would get us off-track from an already lengthy story. Feel free to ask me about it, though.

Anyway, back on track: I started to have the urge to push, so I did some practice pushes with the nurse. Pushing was the part of labor I felt like I knew the least about, but I knew that my body would guide me. Albeit, now with an epidural I did worry a bit that my body might not be able to tell me what to do. I let the contractions guide me and I pushed to the point of comfort. At some point in this, baby’s heart started to have some decelerations. This seemed part of the deal to me: I was pushing, I’d had an epidural, it made sense. (Thank you, Thinking Woman’s Guide to a Better Birth.) But, Dr. M came to talk to us about it. She referred to the decelerations as “dippy doos” and encouraged me that it was time to get baby out. With her small frame, girly voice and baby talk, she reminded me of the Dolores Umbridge character from Harry Potter: utterly charming on the outside with a voice as sweet as honey that was used for spewing nastiness. She left and I continued to push to the point of comfort. When Dr. M returned, she was more adamant that I get baby out. She said I had thirty minutes or I would need to get wheeled down the hall for a c-section. I continued to work on my pushing and invited nurse Lara to coach me because I had lost all urge to push on my own.

We worked for a bit on it when Dr. M returned to check on me. This time, it was pure nastiness. She asked me if I had even been trying and told me I wasn’t doing a good enough job. I invited her to coach me through some contractions herself. She encouraged pushing hard and long, to the point I thought the blood vessels in my eyes might burst. I needed oxygen to make it through. It felt so wrong, but I knew that she could call it done at any moment. We were well past the thirty minute deadline she’d set. The doulas and Dave took turns holding my hand and legs. Doula J was amazing and whispered gentle encouragement to me. Dr. M yelled at me, used sports metaphors, berated me. I think she meant well, she was genuinely concerned for my baby and was trying to find something to motivate me. But, all of those were the wrong thing for me. I had prepared for a gentle birth guided by my intuition. I thrive off of positive words. Eventually, she said something about getting mad that resonated. The idea of getting mad at a pain was something I recalled from Bradley class. I focused on that. I am not an angry person, so I tried to focus on things that make me mad. Dr. M was one of them. I was mad at her and her infuriating approach. The other things I could think of were social injustice: rape, starvation. But, those are not things to think about during birth, so I summed it up as evil, as Satan. So, that was my focus: anger at Dr. M and at Satan.  If I could push harder to get her to shut up, then it was worth the anger.

At some point in there, they got the mirror in place for me to see baby’s head and I got to feel it. It didn’t mean much. I couldn’t really see in the mirror or feel much. All I knew was that focusing on those things was taking my concentration away from pushing. So, I had them remove the mirror. Later, I was sad to not have been able to see the actual delivery, though I am told that Dr. M would’ve insisted on it being moved.

Finally, after all of that it was time for V to come out. Dr. M was shocked that it was going to happen. She was still telling me that I couldn’t do it. Yet, he was coming, really coming. The final moments were faster than she’d thought since she just didn’t believe it would happen. I was told to stop pushing while the resuscitation team assembled. (I don’t think I listened to her to stop pushing—ha!) We knew by then that they would take V immediately to the table in the room because of the decelerations and the meconium. We agreed that Dave would go with him. So, when I pushed him out, I was happy and surprised that she laid him on my torso for a moment. I remember him looking wet and grey. He was silent. I wasn’t worried; I was just taking it all in.  I saw the cord for a brief moment. Then they moved him to the table and he made his first cry—small with a squeak at the end.

I wanted to know how his spine looked, as we’d been concerned about a neural tube defect.  It looked fine. V was born at 4:56 PM and weighed in at 6 lbs 12 oz and 20 in long. His first APGAR was a two, but by five minutes he was at a nine. The second stage of labor (pushing) had lasted 3 ½ hours.

Dave and Doula K were at the table with V. Doula J might have stepped out. During that time, Dr. M continued to work and I felt strange sensations. I felt like I was going to have bowel movement. When I asked her what was going on she laughed at me and told me it was the placenta coming out. Records indicate the placenta was delivered just three minutes after V’s birth, so I suspect she was pulling it out, despite our wishes to the contrary.  I got distracted with what was going on with V and the cord and placenta were gone before I could ask about them or see them. I later learned that Dr. M has a reputation of thinking placentas are gross and disdaining patients who don’t share this sentiment. She also told me that I was facing hemorrhage and needed to have Pitocin. I asked her to wait, but very quickly she brought it up again. There is nothing in her records that indicate a hemorrhage, so I suspect it was just another case of her doing things her way. She never said anything about stitching me or if she administered medicine to do so. But, she did tell me that I had torn because not only had V been born in the very challenging OT position where the largest part of his head was coming first, but his face was to the side with his hand by his head (nuchal hand). At some point, I learned that it was a third degree tear plus a partial. Only months later would I also learn that the nerves in my pelvis had been damaged.

After a few minutes, Dave brought me our V. He was calm and very alert and I could admire his dark blond duck fluff hair and his big, round eyes. They were either hazel or very dark blue--it was hard to tell then.

He had long, scraggly fingernails and his feet were dried out and wrinkled like an old man’s. His ear was folded down from where he’d been touching it on his way out. We did the breast crawl, something I had long dreamed of seeing. Babies are born with such incredible intuition!

We were enamored by this little boy—an answer to prayers, a bringer of joy. I had long felt like a mom who just didn't have a child of her own, but now I finally did.

Family Photo

A well-deserved rest