Birth Story!

A client shared this story with me to publish on our blog.  I love this family, and have been honored to help welcome both their sweet kiddos.  Enjoy! -L

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Amelia Ane’s Birth Story

My second pregnancy had been much harder than my first, both physically and emotionally. I had been very sick, more aches and pains, and I really struggled to find and hold onto the peace and beauty of the process. For several reasons, we were all CONVINCED this child was arriving in its 38th week. My mom wasn’t getting into town until after 39wks though, so we were happy when I was still pregnant at 39.3. Then I was still pregnant at 39.5, when I stopped working and started my leave. Then I was still pregnant at 40.0, and 40.1, and 40.4. On the morning of March 24th, 40 weeks and 5 days, the same gestational age I went into labor with my first baby, I woke up to some contractions that were clearly something more than Braxton hicks. They needed some of my attention, but weren’t terribly strong. I told Mark that I didn’t think he was going to work that day, but that we’d re-evaluate after he’d dropped Archer off at school. As we got ready, the contractions kept coming, though they were still not terribly strong and I was a bit worried that I would be the girl who cried labor. I gave my midwife a heads up around 7am and alerted our son’s best friend that they would likely be picking him up from school.

After my son was at school and the house quieted down, my contractions picked up in both frequency and intensity. I had been worried about a precipitous delivery, because my first labor had progressed rather quickly towards the end. I was happy then, that this labor seemed to be starting gradually. I was able to bake a birthday cake for the baby, which I had also done for my first. As I worked through the increasingly challenging contractions we decided that it might be best for my midwives to come and give me my first dose of antibiotics (I was GBS+ and opted for them). I think everyone was pretty convinced that this would be a quick and efficient delivery. They arrived around 10am, I got my drugs started, and retreated to the quiet bedroom with my husband. My labor seemed pretty sensitive to what was going on around me, and I wanted to keep things going. I really only wanted to be upright, mostly standing and leaning against something with pressure relatively high on my back. As the antibiotics were going in, the contractions kept getting stronger and I was looking at the inflated but not yet filled birth pool, really wanting to get in. Filling that thing took way longer because of our crappy hot water heater. I moved around our room in various upright positions, working through my contractions with Mark putting pressure on my back and my mom holding my hands. Contractions were about 3 minutes apart and a minute long at that point. Linsey alerted the photographer that is was probably time to come.

When the pool was finally full and hot- I got in and was immediately disappointed. I seem to prefer being pretty upright in labor, so I want to be on my knees, and still have the water over my belly and back, but no pools seem deep enough for this. Also, I don’t personally find that the water makes the contractions any less intense, though it does help me relax in between them. I did finally find a position in the water that I liked, and continued laboring there for a while. My contractions slowed down quite a bit in the pool. After an hour or so Linsey suggested that it would be good to ‘get reacquainted with gravity’, so I got out and things picked up immediately. I knew that I wouldn’t be getting back in the water at this point, it had slowed my labor down so much.

Contractions kept getting stronger and stronger, and were becoming difficult to get through. I started feeling like I couldn’t take it much more, but at the same time, I felt like I KNEW that must mean I was in transition and would get to push soon! That knowledge totally kept me going. My water had not yet broken, and I kept waiting for it to go, thinking that as soon as it did it would be all over. It came time for my second antibiotics dose, and Linsey asked if I wanted it since she thought baby would be here in less than an hour. I said no….. but then a half hour later nothing really seemed to have changed. Linsey suggested checking me just to see if I should get the next dose. I’d had a really disappointing experience with a cervical check at my first labor and I didn’t want one this time, but it did make sense. I was checked and only a stretchy 6cm.

After all that ‘transition labor that was not transition’ I was pretty crushed. In my first labor, I had a really hard time telling my support team when I was struggling. I was embarrassed to admit when I felt scared or anything less than a strong birthing goddess. This time, I was pretty vocal about it. My whole support team really sprung into action here- reminding me that I had made very quick progress with my last labor so that 6cm reading could be meaningless. My legs were really starting to shake from the effort of keeping me upright for so long, and I just couldn’t take the pace and intensity of these contractions while trying to get my mind back together and focused. Linsey suggested I try laying down to get a break while the second antibiotics dose ran in, which I did, and the contractions did space out a bit. Even better, I could actually rest in between them. While I was laying down my mom, Mark, Linsey and Susan talked me back together. I even made Linsey remind me just how long it would take for me to get an epidural!

 

After a while it was clear that I was going to need to get vertical again to finish this labor out, and it was going to get even harder. I won’t pretend I was super graceful about it, but I did find some amount of focus and determination to keep going. I got up and kept going either standing or kneeling around my bed, still with Mark giving counterpressure and my mom holding my hands. I absolutely would not tolerate any other arrangement. I would stare blankly through the contraction and repeat in my head ‘I will let this open me, but I will not let it pull me under’. It felt like a battle of will at that point. I still really felt like the hold up was that my water hadn’t broken, and was even starting to try to give a little push with contractions to force it. Susan suggested sitting on the toilet or squatting to encourage my water to break. The toilet seemed like a good idea.

 

I had a few contractions there, and while my water did not break, I did get my first ‘ok I really am pushing now!’ contraction. Everyone came flying in, because I had pushed my first baby, a nearly 10lber, out in 25 min, so we were not expecting me to push much. They got me off the toilet and back to the bedroom where I went back to standing at the dresser for the next contraction that came, thankfully I did not have the same pushing urge there, because I did not want to deliver standing again. Linsey had me come over to the foot of the bed and kneel then, while I still could. At either the next contraction, or the one after, my water FINALLY broke, and as predicted, it was all over from there. I was totally wild with needing to push this thing out of me, but I did try to hold back as much as I could in an effort to slow delivery and minimize damage to myself. I yelled A LOT. At one point I thought I had delivered the head, and got really freaked out when I still felt the intense pain and pressure of crowning. I said something like ‘no guys, this really really hurts, something’s wrong’. To which they replied, ‘that’s because there is a baby coming out of you but it’s not out yet’. I’m sure I sounded insane, I pretty much felt insane. The contraction right after that, though, I delivered the whole baby, who was gently lowered to the floor underneath me. I reached down, and saw that it was a GIRL! I got her untangled from the cord and picked her up. Heavens that feeling of holding your wet, delicious, perfectly squishy newborn that you’ve worked so hard for is like nothing else in the entire world. Mark was next to me and I could hear him crying with excitement and joy. I had to check again to confirm that she really was a girl, I couldn’t believe it. She was an angry little thing, so I offered her a breast (what else do you do for an angry baby?), which she took to pretty much immediately.

 

After much snuggling and ooing and ahing, we cut the cord and got ourselves into bed. I got checked out and had only minor tearing which was a welcome change from my first delivery. In general I felt much better this time, not nearly as woozy, and I was able to stand much sooner. Eventually we all got cleaned up, tucked in, had our celebratory sparkling cider, and got around to talking about food. I stayed up pretty much the whole night taking her in, and dealing with the afterpains, which were quite intense for the first day or so.

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I had hoped that the baby would be born with plenty of time for our son to come home, have some birthday cake, and us all to get into bed. In the end, we weren’t ready for him until after 8pm, which was well past his bedtime. So he stayed with his best friend, and came home in the morning. I was SO ready to see him by then! I missed him so much. We had gotten some things for the baby to give to him, and he had chosen a stuffed giraffe to give to the baby. It was like Christmas morning, watching my kids give gifts to each other, then having my whole family snuggling and playing in the bedroom together. I think that morning will always be one of my fondest memories. There have already been plenty of tantrums that I’ll just try to forget ASAP.

 

When Midwives were Illegal

Memories

Today, an old friend gave me a copy of this newspaper article (can be found behind a paywall here).  Published eight years ago in January 2008, I might as well tell you, that is me there on the cover, listening to the new baby's heartbeat.  At the time, I was a fairly new apprentice, working with a wonderful underground midwife.  I was 28 years old and about 15 weeks pregnant with my second child.  Looking back it honestly seems a little crazy that I was on the front page of the newspaper committing (or helping to commit) what was then a quite illegal.  I had a small child at home, and a lot to lose.  My senior midwife's husband is quoted in the article, "'every time she walks out the door I wonder, Is the next time I talk to her going to be in a jail cell?...It petrifies me'".  I don't think my own partner was quite that worried yet - after all, I was just an apprentice.  But the threat of arrest, discovery or investigation was constant.  I did not know that Certified Professional Midwives (CPMs) would be legal within a year.  I planned to be a midwife either way.  Sometimes I forget what that urgency - the urgency to start practicing and helping - felt like, and why it seemed so important.  Why did it seem worth risking everything?  People who have had out of hospital births in the last few years in Missouri cannot imagine how different it was and how limited the options were for pregnant women.  I was both a pregnant woman and a provider in an illegal state, and I want to start my new blog by sharing with you what that was like. 

Pregnant in Missouri, 2004

Shortly after we moved to Missouri in 2003, we decided to start a family.  I had some vague thoughts and ideas about birth, mainly that I did not want to go to the hospital, but didn't think much about it until about a week after I found out I was pregnant and went looking for midwives.  We had moved from Texas where midwives were everywhere so I opened up our new phone book (it was 2004!) to the "M" section for midwives and found..... nothing.  I looked under "B" for Birth Center.  Nothing.  Alarmed, I went to the internet. 

There was never any doubt in my mind that I would have an out of hospital birth.  My own birth had been traumatic for my mom - a typical forceps delivery in the 1970's from which I bore a scar throughout my childhood.  She told me stories of how the nurses wouldn't let her squat or shout.  It seemed absolutely barbaric, sexist, dehumanizing and dis-empowering.  I did not want that for me or my baby.  My friends in Texas, however, had all had straightforward home births with one of the many, many legal midwives there.  The choice seemed obvious.  But, to my horror, it appeared I had no choice. 

After a few weeks of internet research I became appraised of the unfortunate facts.  Certified Professional Midwives (CPMs) were illegal in Missouri (and Illinois), period.  Certified Nurse Midwives (CNMs) worked under highly restrictive collaborative practice laws and did not work as primary care providers in any capacity - home, birth center or hospital - in the St. Louis area.  There was one homebirth physician (the late and lovely Dr. Duhart) in St. Louis, but I did not want a man delivering my baby.  My only option, it seemed, was to travel to another state or find an underground midwife. 

Finding an underground midwife, as you might imagine, was not easy or simple, even for an obsessive planner like me.  I posted inquiries on the St. Louis Friends of Missouri Midwives listserve (remember those?) and on an online message board.  I called the hotline that FOMM had set up to screen prospective clients but no one called me back.  The idea was that eventually, hopefully, someone would screen you either on the phone or online, then pass along your information to the midwife who would then call you.  It was clunky, crazy, and made me feel like I was brokering an illegal arms deal or trafficking cocaine not trying to have a baby at home.  Finally, after weeks of dead ends, my eventual midwife's apprentice contacted me.  It turned out that during the year my first son was born, there was only one midwife serving the greater St. Louis region.  Now St. Louis has between over a dozen practicing midwives.  I don't have to tell you that, despite the screening process, she was busy.  

By the end of my first trimester, I had established care with St. Louis's only practicing midwife.  I felt lucky because I knew that some women never figured out the right people to call and ended up having an unassisted birth or an unwanted hospital birth.   

My pregnancy was uneventful and my birth was straightforward and enormously empowering.  Aspects of the illegal nature of home birth dogged me though.  Though I liked my midwife, I was frustrated that I had no other options.  I hated how paranoia and protectiveness were woven into my pregnancy and disliked how there was little interaction between the midwifery community and the medical community.  Tests and procedures (labs, ultrasounds) were too difficult to obtain so I did not get them.  I knew that a transfer would be crazy so I put that possibility out of my mind and hoped for the best.  I was lucky!  Everything went well.  So well.  The months following my birth I became enraged and obsessed about the lack of options for pregnant women in Missouri.  A new midwife was working in the area.  I contacted her and began an apprenticeship and friendship that lasts to this day. 

Apprenticing and practicing midwifery in Missouri, 2006-2009 (identifying details have been changed)

Attending births in an illegal state was bizarre.  At the worst, we had to lie and parents suffered legal trouble and trauma. 

One of the first 15 births I attended jumped me into the realities of the legal situation. There was an emergency and 911 was called, but as is sometimes the case, by the time EMS arrived, everything was fine.  When the police showed up with the paramedics, we quickly changed out of bloodied clothes and pretended to be doulas and friends.  The police wanted to press charges against someone and definitely did not want to leave without sending the family on the ambulance.  An hours long standoff ensued that was difficult and scary and to this day I feel lucky that we were not arrested. 

A couple years later, I helped another midwife with an emergent transfer to the hospital.  After the midwife gave all the important clinical information to the staff, we changed clothes and stayed in the waiting room, unable to check on our client or provide information or care.  At one point staff came out into the waiting room looking for "those midwives" and though we were desperate for information on our client, we had to pretend to be visitors of someone else. 

That same year a client told her doctor that she had accidentally given birth unattended at home.  This was fairly common in "the bad old days" when women had to lie to protect their midwife.  Although she had a simple, low-risk home birth, the doctor called DCFS and the family spent the next several months dealing with an investigation.  This would happen again a year later to another client. 

These are some fairly common examples of what I experienced of a system that routinely forced midwives and clients to lie.  Illegal midwives had no access to basic, lifesaving, medications like pitocin, methergine, vitamin K and IV fluids.  There was no access to lab work or ultrasounds.  Women who wanted these things were forced to hire OBs and lie to them about their birthing plans.  Clients could not share the names of the midwives who attended them with friends, family or online.  Finally, there were no standards and no accountability.  Missouri still lacks licensing for CPMs, but at least CPMs are legal.  Before 2009, many Missouri midwives did not complete the CPM training, mainly because there was no point.  Serving women was a felony either way.  

All this would have been just an unfortunate problem for folks on the fringe if there were great hospital choices.  There were not.  Until recently, there were no Certified Nurse Midwives catching babies in hospitals on the Missouri side of the river (there was one in Illinois) and OBs who supported natural birth were very few and far between.  The nearest birth center was 100 miles away and the largest maternity hospital routinely separated newborns from their mothers for admission and didn't even have showers in the labor rooms.    

So, often prospective clients ask me in interviews why I became a midwife.  It can be hard to articulate to people who have never known what it was like to have no options for childbirth. It was that backdrop of limited options that drove many of us to learn, to help and work.  It is a completely different St. Louis today, eight years later.  There are seven or eight CPMs and somewhere around 10-15 CNMs working in the area.  More are training.  There are birth centers. There are even showers and tubs in that old hospital!  Its incredible.  The details of my life as a legal midwife are so different it astonishes me.  I will never take ordering a lab or buying a vial of Pitocin for granted!  I will never hesitate to use the Pitocin I have for fear of not being able to get more.  Not only do we not lie to doctors, hospitals and EMS, but we actively share information and charts.  Every time I call the hospital or a physician to talk about an issue with a client, I am almost giddy with astonishment.  This all makes out of hospital midwifery much safer for women and babies.  It continues to be an interesting transition.  Though I have my grumbles about various legal issues, it is good to really think about what it was like before and how far things have come. 

Where are we headed?  When midwives were illegal or not practicing, families were very motivated to help.  Hundreds of people showed up at cookie day in Jefferson City and dozens more regularly lobbied to decriminalize CPMs.  The next step should be licensing so that CPMs can be more integrated into the medical system.  This will make out of hospital birth safer, both through standards, access and accountability.  Also, the law that makes us legal is very small.  The possibility is ever present that CPMs will become illegal once again.  Licensing will help prevent any legislative surprise that would limit families choices once again. 

What can you do?  Join Friends of Missouri Midwives for updates on legislative matters.  Also, please attend Cookie Day if you can, it really does help for lawmakers to see how much families care about birth choices.