Midwife Monday – My second birth story!

Whew! It’s a warm ZERO degrees in Alaska this morning – and that’s the high temperature for today. Happy Monday! Just a heads up – this is a longer post today – but I feel strongly that it has many elements to educate, inspire and empower everyone. With that said – here’s my second birth story!

I found out I was pregnant after tracking my LH surge with OPKs (ovulation predictor kits). I thought my period was coming because the hcg on the pregnancy test was negative through the day I should have gotten my period. Alas, the next day the little double pink line showed up – it was just was just a little later than expected.

My second pregnancy was low-risk and uncomplicated. The husband and I decided to do a surprise again – and this time, we were convinced we were having another girl. I worked full time throughout the entire pregnancy, even working 24 hour shifts through 36 weeks. The day before delivery, I was in the clinic seeing patients and decided to have my cervix checked. I hadn’t had my cervix checked up to that point, but the next day was a holiday, and my plan was to have my cervix checked on my due date if labor had not commenced by then. My daughter’s labor had started at 39 weeks, 5 days and she delivered at 39 weeks, 6 days. Here I was at 39 weeks, 6 days, and no signs of labor except for some uncomfortable contractions that morning. My provider checked my cervix and said I was 3 centimeters, 50% effaced, and -2 station. The baby’s head was very low, well-applied to the cervix, and the cervix was very soft. The provider and I talked about stripping my membranes – also known as membrane sweeping – as an intervention to help stimulate labor and we decided that it was a good idea (read more about membrane stripping here) .

In all honesty, I really wanted to labor at home for 90% of my labor, and present in transition. I also wanted to deliver on a weekend or in the night time. Since I work in the hospital and on the labor and delivery unit, it’s always nicer to be the patient when there are less people around that you know. That may seems strange to some people, but I have always felt that way. I labored at home all day on a Saturday with my daughter before she arrived shortly after midnight on a Sunday – it was perfect.

After the membrane sweep, I went home, had dinner with the family, and put the toddler to bed. Our toddler was sick, and every 3-4 hours we were waking her up at night to give her medicine for her fever. While giving her medicine at 2:00 a.m., my water broke while leaning over her crib. And by broke, I mean it flooded. I had to pick up a blanket from inside her crib and put it between my legs there was so much leaking fluid. At first, I was in denial – aren’t we all? But then the amniotic fluid continued to leak and leak and leak. I woke up the husband and told him my water broke. Around 3 a.m., our neighbor came over to watch my daughter. After she arrived, the husband and I were trying to decide if we should go to the hospital. I was contracting fast and painfully. My midwife mind said it would be a fast labor so I decided to check my cervix. I was 4 centimeters dilated, 80% effaced and at -2 station. Because I was contracting so painfully, the husband really wanted to go to the hospital. We only lived about 10 minutes away, so we hopped in the car and off we went.

I should preface this next part with: I am a terrible patient. I don’t like attention and I don’t like to be the center of attention. Alas, in labor, you can’t really separate these two dislikes from the process (okay, you can have a home birth – but that wasn’t in our birth plan). So, we arrived at the hospital around 4:15 a.m., and walked onto the labor and delivery unit. I didn’t call the nurses so they had no idea I was coming (please don’t do this to your unit, again, see preface about terrible patient above). As expected, they were surprised to see me. I requested that they not yet admit me to the unit and that I wanted to walk around the unit until the contractions were stronger. The nurses notified the OBGYN on call that I had arrived and she ordered a nonstress test and an IV started. I was fine with that even though that’s not what I wanted. What I really wanted were some of those awesome postpartum pads because I soaked three more pairs of pants while getting my nonstress test. The other thing the provider asked for was a cervical exam. In her words, she “wanted an exam on the chart.” My response was “If you think that is necessary.” I only mention this because in hindsight, I don’t think an exam was necessary and I think it was something that could have been delayed. It’s always important to verify presentation – but this can be done by Leopold’s or by an ultrasound.

After my monitoring, IV start and cervical exam, the husband and I walked around the unit to help me cope/distract me from the contractions. I had to borrow a pair of scrub pants from the unit to walk around because I had leaked so much more amniotic fluid on all of the clothes I had brought in my bag. I only made it a few laps before the contraction pain was really amping up and walking felt terrible. Well, everything feels terrible, but there is a stark difference between contractions with your bag of water intact and contractions with your bag of water ruptured.

I decided to go back to the labor room and get in our shower tubs. Shower tubs are what you see in the picture below – a stand up shower with a shelf to sit on, that also has a door that closes to make the shower a tub. The water can fill to the height of your chest and this helps relieve a lot of the contraction discomfort. Unfortunately, it takes about 10 minutes to fill the tub and that was a somewhat terrible 10 minutes. Once the water height got above my belly, I began to feel better. The contraction pain remained intense and I felt more and more pressure with each contraction. In my mind, I was thinking – “I am going to have to get an epidural….this pain is terrible…how am I going to keep going?” and at the same time I was thinking my mantras – “You can do this. You are strong. You and the baby are doing great.”

At this point, I decided to try and check my cervix while sitting in the tub. It was about 6:00 a.m. at my best guess. I was able to easily reach it and alas – I was 7-8 centimeters! I was renewed in my spirit and knew I was close to birth. The next 20 minutes were very intense. I was transitioning. I was shaking. All I could do was go from one contraction to the next!

Then I started to feel the urge to push. I knew I was pushing instantly and I told my husband – “Go get the nurse.” He didn’t hear me. So I told him again – “Go get the nurse.” This time he heard me and moved quickly to summon help. Within seconds, the nurse walked in and said “Oh, you’re pushing!” She started draining the tub rapidly, and started to say “We’re going to need to go back into the room…” I said: “The baby is coming on the next contraction.” And sure enough, on the next contraction, I felt the urge to push and while still standing in the tub, pushed with the contraction and delivered the baby’s head. I wasn’t sure if the baby had delivered despite feeling some relief in pressure and looked around the bathroom frantically for some coaching. I asked: “Is the baby out?” The nurse said “The head is delivered!” And then I pushed with all my might one last time and the rest of the baby was born!

Because I was standing, the first thing I wanted to do was sit down. So I sat back down on the tub shelf and looked down at the baby nestled in towels on the floor of the shower. It was a boy! I immediately shouted joy that it was a boy and scooped him up. I looked for my husband in the corner of the bathroom and shouted “It’s a boy!” The picture below is within minutes of him being born! Pardon the “I just had a baby hair.” And yes, his face is blue because he came out a little fast.

Oh, we were (and still are) so happy to have been blessed with a boy. My labor was fast – only about 4 hours, and I delivered within about 2 hours of arriving to the hospital!

I feel passionate about sharing his birth story because it has highlighted some important aspects of birth that I think are vital to supporting women in the birth process. First, we must listen to women. The provider that was on call when I arrived to the unit didn’t hear me when I tried to voice that a cervical exam was unnecessary. She didn’t give me an option for anything else. She also didn’t come to the bedside to see how I was doing the entire time I was in labor except to perform the cervical exam after admitting me, and then arriving in the bathroom for my precipitous delivery.

Second, during my time in the tub, the provider had ordered fetal monitoring outside of the parameters of guidelines for intermittent monitoring. I even remember telling the nurse when she told me how often the provider wanted to monitor me – “That is not evidence based.” I already told you guys that I’m a feisty patient. We can’t support woman well in natural birth if we aren’t practicing to the guidelines that support when and when we shouldn’t do something. Natural birth happens through a process that is very primal and very predictable. Interruptions and interventions don’t move natural birth forward, they usually slow natural birth down. My nurse was lovely and said “I’ll go talk to the provider.”

Third, as a branch off the last statement by my nurse – nurses must be patient advocates. People are insane if they think birth isn’t a team sport. Pregnancy and birth take a village – just like mamahood and parenting. Sometimes nurses are more seasoned than their providers. Sometimes nurses see what a provider doesn’t. Don’t ever be afraid to stand up for what is right for your patient.

Lastly, we must support and walk with women through each contraction and every cardinal movement of birth. As providers, we have the tendency to expect women that have had babies before to just do it on their own because they have done it on their own before. This is unfair to women. I needed someone to tell me what was going on in pushing and had to ask for guidance because it wasn’t being given. We must coach, support, and lift up women through every stage of labor.

I know you might think it strange that a nurse midwife had her two babies delivered by OBGYNs. Why didn’t she have a midwife come to her deliveries? The answer is pretty simple – for the first delivery, my OBGYN on call is basically an OBGYN in midwife shoes. You find these OBGYNs every now and then. They are absolute gems and have my upmost respect. Most of the time, they are wise enough to know how to support and protect natural, active labor and they have garnered much patience over many years of assisting laboring women. This patience (and a critical eye) help them to know when to watch with a comforting voice, and when to intervene in a process that appears abnormal.

My second OBGYN was the opposite end of the spectrum described above. She didn’t know how to support natural birth or provide guidance during natural birth. And she didn’t ask what my plans or desires for my birth were.

I provide these examples as a woman and a midwife that has been humbled by both of her births. I hope my words provide you with inspiration about birth (but please don’t try to check your own cervix at home), but also some education and insight about how you should be treated during birth.

Did you miss my first birth story? Check it out here. Want to share your birth story? Please share here! Have a wonderful day!

Jamie

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