I am sharing this with you all, with some hesitation. I am normally very private but I thought folks might enjoy a midwife's birth story. This was a pretty medicalized pregnancy, and not the most gentle birth. But every birth is different and this one was beautiful in its own way. Unless noted otherwise, the photos are from JJ Lane at BeLovely Photography. I am so glad we hired a birth photographer! I have tried to link it heavily to explain terms and whatnot.
Ephraim's Very Fast Birth
When I was pregnant with my first two babies, homebirth midwifery was more or less illegal. I had simple, easy homebirths with underground midwives. Of course I knew that doctors and hospitals provided valuable services for moms and babies who needed them, but I thought, not me, never.
Eleven years older physically and with eleven additional years of maturity, this pregnancy was quite different from my previous two. With my first baby, I never had an ultrasound. I never had any blood work. I did not test for GBS or Gestational Diabetes or listen to my baby's heartbeat for more than a few seconds at a time. Part of that was the type of underground midwife I was forced to hire the first time (and the laws that limited her access to medications, tests and education), part of it was my passionate belief that pregnancy was not medical and part of it was that I was young and super duper healthy. This time, however, I had an early diagnosis of gestational diabetes. Even though I am fit and eat well, a combination of genetics, age and weight made this unsurprising. Much more comfortable in the medical world now, I made an appointment with a team of OBs and Midwives and started concurrent care early in pregnancy. Now, let me share that though I adore the CNMs that took care of me (Becky Hassler and Caroline Mank at SluCare are wonderful!), and appreciate the experience and expertise of the MFMs and OBs that oversee the practice, I did not particularly enjoy visiting a large OBGYN office every few weeks. Later it was every few days. I can see why people hate it so much. Waiting rooms with TVs that cannot be turned off, rules, grumpy nurses, coughing children, tired physicians, surprise bills, the endless ebola screens. It was so different from my other pregnancies.
During my first pregnancy, my prenatal care was conducted by a midwife working out of a trailer she drove around the bi-state area. She did prenatals in a trailer park in downtown St. Louis, lawn chairs outside for you if you arrived early. You'd smile a little at the retired people, who watched the parade of pregnant women and big families with raised eyebrows. Appointments were long and leisurely. There would be jokes, a small payment, natural and sometimes questionable medical advice and peeing in a cup in a very small bathroom. Prenatal care for my second pregnancy was also a low-tech affair. For baby #2, I had a different midwife, a peer, and we mostly met at my own house. We would sit around, chatting about midwifery stuff, sipping tea, while my toddler jumped around. This time, however, every appointment seemed to involve a new test, new lab work and another exam. There were many medical people and their medical opinions, protocols and rules. I had tons of labwork, a flu shot, prenatal Rhogam, Dtap and several ultrasounds and other fetal surveillance. It was all fine, completely warranted and absolutely what I signed up for, just annoying and very different. Sometimes I missed the long skirts and piles of herbs, but not much. Susan checked in on me too, but I am a terrible patient and didn't make her deal with me too much. :)
All along, despite engaging with SluCare, I had planned to have this baby at home with Susan. That is where I felt comfortable and safe. With two quick, straightforward births behind me it seemed a little ridiculous to go to the hospital. Plan B, of course, was the hospital if anything exciting came up in pregnancy. Besides feeling old and miserable, the pregnancy was actually pretty uneventful. My blood sugar was just fine with diet and exercise, the baby was an utterly average, healthy size, the extra tests because of my age were normal. I walked four miles, four times a week. I imagined I would have this baby before or around my due date since Hugo, my first, came two weeks early and Julian, my second, arrived on his due date. I though of May 1st, my due date, as the absolute outer limits of the pregnancy. Even though I should absolutely know better, Mayday was it. Beyond that I had not imagined. So, when the CNMs suggested an induction at 41 weeks due to GDM, I agreed, cheerfully, knowing that I would never, ever be pregnant that long.
As May 1st approached with no discernible signs of labor I was excited. I wanted that May 1st birthday! Don't do as your midwife does, they say..... I made a plan to take castor oil on May 1st, confident that, like many multips before me, 2 ounces of the thick, dusty-tasting oil would bring my baby into the world. I felt like there were enough medical concerns to justify an eviction and I was feeling totally done. It didn't work! I drank four ounces that day, four hours apart, straight. I ended up with absolutely nothing to show for it except a few hours of contractions (and the expected results of a quadruple dose of laxatives). At one point contractions were fairly strong and 3 minutes apart as Adam and I walked through Francis Park. It was a beautiful day at least, if you're going to spend an uncomfortable day not being in real labor. We took selfies in front of a sculpture, sure that they would be the pictures marking the beginning of labor. Ha!
Sleep deprived, achy, exhausted, irritable, I was miserable the next morning. Surely the baby would come that day. No. Or the next. Nope. How about another several ounces of castor oil over the weekend? Nope. I binge watched depressing shows on Netflix and frittered the days away cleaning, gardening and stewing.
I stopped working because I didn't want to subject my poor clients to my crabby moods. Meanwhile, I went to see the hospital based midwives for my third or 4th NST and BPP. Previously they had been perfect. At 41 weeks, May 8th, I could see immediately that my fluid was very, very low. Previous ultrasounds had shone dark, deep pockets of fluid and a baby gliding through a buoyant uterus. This time, there were just thin streaks of fluid at the margins of a much quieter baby. The ultrasound tech gave me a generous AFI and Deepest Pocket measurement that were still pretty bad. Luckily, we passed the NST so we weren't told to go to the hospital right away. An induction was scheduled for the following morning. Obviously it was time for my baby to come, no joke or special dates this time.
I began to lose perspective - everything felt like a disaster - and objectivity. As many of my clients, friends and family can attest – I was a mess at the end of this pregnancy. I was already eight days past when I thought I would absolutely be done being pregnant. Eight days that felt like eight months. And while I had always said that I would happily go to the hospital if I needed to, now that I was facing an 8am induction, I began to panic. I realized that, no, I did NOT want to have my baby at the hospital. I wanted to be at home with my kids, my bed, my fridge, my coffee.....I knew labor would probably be fast and intense and I did NOT want to deal with that at a hospital. Most importantly, I did not want to be stuck in the hospital after birth, with nurses and students bothering me. I am a very private person and I love quiet. I love quiet and I hate strong smells. Beeping, especially, drives me insane. I knew that I would do fine if an induction ended up being necessary the following day, but I felt like I had a few hours to safely make this baby come at home.
The specter of a hospital birth loomed, and I made another plan. I took castor oil again in the afternoon, and again, it did nothing. I was thoroughly demoralized. Susan came by in the evening, planning to break my water as a Hail-Mary pass. It is our experience that women who are post-dates, multiparous with an excellent bishop score can expect AROM to start labor. Its never a first choice, there are definitely risks (labor not starting, cord prolapse, making a bad fetal position worse) but since I would be heading to the hospital in the morning anyway, my bishop score was great, I thought it was something I could try. Now, Susan and I get along as well as two people working together in an intense, low sleep job possibly can. But I am not a good client or patient, and I feel bad for the people taking care of me. I know there were tears and I may have yelled at her when she told me that the baby was too high for her to break my water. I was 3-4cm, -2/-3. I was pissed. Angry at her, angry at the universe, angry at myself. I went on a furious and tearful walk with Adam and hatched yet another plan. Again.... do as your midwife says, not as she does ;)
In the end, we ended up calling a retired midwife who was known for her AROM willingness and abilities and also her proximity to the hospital should anything crazy happen. Susan and I drove to her house about 15 minutes away. It felt a little awkward, but she checked me on their guest bed. Her assessment was the same as Susan's, but with maybe a slightly more generous assessment of station. Her words were magic to my ears!
“Well, I've done crazier things,” she said on exam. That sounded good to me, so I told her to break it. We had brought along an amnio-hook and some pads, and without fuss or discomfort, it was done. The fluid was scant but clear, baby settled down a little lower and his heart-rate was fine. I was thrilled.
Within moments I had a contraction. Before we left her house I had two more. She and Susan chatted for a minute about something and I had that unmistakable, intense need to be HOME. On the fifteen minute drive back to my house, they were coming every 3 minutes, strong enough that I could not talk. For some reason I decided to count through them in my head. I knew that around the count of 15 or 20 the pain would be as intense as it was going to get, and then it would get easier. I watched the clock in Susan's car, amazed by how fast they were coming. I tried to manage a conversation but by the time we were back in the city I was basically done talking. I managed to text my husband to get the kids to bed – I did not want to deal with them when I got home.
We say every labor is different. Yet, I was still surprised by how sharp these contractions were. I would not have characterized the pain of my previous labors as sharp. It felt like daggers in my pelvis, truly, like bones grating against bones under force. Perhaps the intensity was because labor was so fast, or maybe because my water was broken (though, it was broken with my first baby as well), or baby's position. Likely a combination of many things. I was just immediately in a whole lot of truly intolerable pain.
When I got home I hung out in the bathroom for a while. During contractions I ran very cold water over my hands and tried to just breathe and count through the pain. A few years ago I attended a birth where the mother counted out loud, in Mandarin Chinese, during every contraction of a fairly long birth. I thought about her now, and how by the end of her labor I, too, could count to 30 in Mandarin! I really, really hoped I didn't have a similarly long road ahead of me.
I was GBS positive and was very interested in making sure I got a dose of antibiotics. I think it was obvious to Susan that there would be no time for that, but I was insistent. Everything else was set up for the birth, so I told her to focus on getting antibiotics started. Again, I am not a good patient! She asked if I wanted to call Sylwinn, her assistant for the night , or JJ, the Photographer, but I was in serious denial that things were happening as quickly as they were so I said no. She did end up calling Sylwinn to give her a heads up. I think it was just five or ten minutes later that she called and said “come now”. Luckily, they both live nearby. JJ lives less than a block away, and made it with just a few minutes to spare, barefoot, running through the rain.
What I had wanted for this birth was for it to be fairly calm and for Adam to be available. The midwife had nearly missed my first birth and Adam had spent most of both my labors setting up the pool, leaving me to labor alone. The energy had been fearful during my first, while Adam tried to direct a lost midwife over the phone while I was pushing and my second just seemed so focused on the birth pool. So, even though this labor was very, very fast, it was also very calm. Aside from the pointless hustle to get the antibiotics started (I think they ran for 5 minutes before I pulled the catheter out) everything was calm. There was a gentle thunderstorm, even. When I was pregnant with my first I desperately wanted to give birth during a thunderstorm – this time I would actually get my wish. The wind tumbled in through the open windows. It was perfect.
Once I left the bathroom, I stood at my dresser while Susan tried to get an IV started. Adam was at my side as I worked through contractions. It was at about this point that I started to wonder why I spent my life helping women through this torture. Was I secretly a sadist? It was so awful and so painful. I think I started to shriek a little at the peak of contractions which were feeling like one long, horrible peak. It seemed unfathomable that things were so painful so soon, and I felt like I must just be a total wimp to be in so much pain.
All birth stories have moments where they become a bit blurry and this is where my linear memory pretty much fails. I remember that Hugo came in and sat on the bed. I remember asking for music and then demanding that it be turned off. I remember people setting things up and Adam holding me up and encouraging me. I remember thinking that this was happening way too fast, why was everyone acting so serious and WHY DID IT HURT SO MUCH?! It hurt so, so, much. I wondered why the hell I was doing this. I questioned the sanity of anyone who didn't get an epidural at the beginning of labor. At this point only an hour had passed since my first contraction.
And then, I felt pressure.
It was a relief to feel pressure and to dare to guess that it might soon be over, but also awful because I loathe the sensation of pushing. I think this is more or less when Sylwinn arrived, and JJ a little after. Sylwinn woke up our oldest son who had just fallen asleep. Although I was a little nervous about it, he really wanted to be there.
I told Susan I thought I was pushing and she agreed. I had two requests from her for my birth: do not let me give birth in the water or on the toilet (my bathroom is very small and I just didn't want that or a waterbirth this time). But for some reason I desperately wanted to be alone and to sit on the toilet. I promised everyone that I wouldn't have the baby there. There was no arguing with me. I sat in the bathroom by myself, with the door locked, for two long contractions. People asked if I was okay. I could feel that the baby was still high so I pushed, making sure he wasn't going to fly out. Then I stared at the white tile, feeling sorry for myself. It was so awful. I thought about all the clients I have seen gently grunt their babies out, and how easy so many women make it seem. I thought about all the people who say that pushing doesn't hurt for them, or for whom is is a relief. It was neither of those things for me. I hated it in all of my labors, but this was the worst. Even though I couldn't feel his head at all, the pressure and power of my contractions was unimaginable. Women with very fast labors often use train metaphors to describe them, and its true. It feels huge, fast and utterly unstoppable. I think I needed those two contractions by myself to decide that I was actually going to do this. There was no way out but through, as I say, so often, to other women.
Back in my bedroom I tried the birth stool for maybe half of one contraction. No way. I decided kneeling at the foot of my bed was my least awful option. In our practice this is probably the most common birthing position and location outside of a tub, especially for women who have given birth before. I held my son's hand for a moment in between contractions, asking him if he was okay. He said he was.
Ephraim was born after just two or three more contractions, but they felt eternal. I thought I would die. I am sure I screamed and know I shouted that I wasn't going to push. It felt like hell, so much awful stinging and pressure like electricity and rocks.
Irrationally I believed I could just decide to stop and go do something else instead. I was surrounded by so much love and encouragement. The three women there had themselves given birth eleven times and seen hundreds of births. They knew this was nearly over and were so encouraging.
But then, suddenly, and at last, there he was! Relief and love and immediately, no more pain.
After weeks of impatient waiting and fiddling to get labor going. After months of worry about his health and my health. After three years of infertility and a pregnancy loss ….. there he was, whoosh! into my arms. Pictures of that moment capture what I remember very well. Ephraim was slick and warm and born! I held him and remember saying over and over “you are here, you are here!” Adam and Hugo gathered around and we all admired this beautiful new baby. He was perfect. My other births were in the water, and I loved that this time my baby was not immediately rinsed off; I soaked in his primal newness. It was wonderful.
I like to do some extra bleeding at birth, so I asked Susan to give me pitocin. I didn't have it with my other births and especially after Julian I felt awful for about a week as my body recovered. This time, I just wanted to avoid any trouble before it started. Y'all, I am so sorry, I had no idea how much that dumb shot hurts! After the bee sting shot, I got down to the work of the placenta. I pushed quite hard to get it out, like I had with my last birth, to just get it over with. Like Julian's birth too, it came with a huge and messy splash of blood. Relief! My 11yo is such a curious, loving little trooper – none of it bothered him at all. He was so delighted with his little brother, and proud to be there. He even cut the cord.
I am so grateful that we had a photographer there to capture these moments right after the birth.
After all that we settled into what truly makes homebirth wonderful. Quiet cuddles, nursing, laughter with friends and family, delicious food, our own comfortable bed, shower and bathroom. The wind through the windows. My younger son came down briefly, and I'm sure he doesn't remember a thing. He curled up with me and promptly fell asleep. Adam, Hugo and I continued to stare at this new creature while Susan and Sylwinn cleaned up, did the newborn exam and cleared out.
Eventually Hugo went back to bed and we were awake in a quiet house with our new child.
How many babies does it take to have a confident first night? Definitely more than three! We were both too nervous and excited to sleep well, but we made it through the night. The next day we started our lives as a family of five.
My first birth was transformative and incredibly empowering. My second birth was quick, easy and affirming. This final go was very painful, lightning fast, but simple, safe, peaceful and gloriously family centered. I am grateful to the team of patient and careful care providers that kept me and my baby safe. I appreciated the warm, collaborative and evidence-based care at SLUcare with the CNMs there. I am so grateful to Susan, who remained patient and tolerant, even when I was neither. Thanks to the midwife and friend who took a chance and broke my water for me!! Thanks forever to Sylwinn who assisted Susan and JJ who took these wonderful pictures. You were both a welcome and gentle presence. Finally I can't say enough for the loving and solid support of Adam, my husband and the geeky, loving presence of Hugo <3