Tuesday, February 20, 2007

Filbertine: The Inside-to-Outside Story

OK, here's the birth story, actually, two birth stories: The quick rundown and the version that you should only read if you are deeply interested in childbirth and not afraid of talk of a wide variety of bodily fluids. If Nutmeg's birth blew my mind, this one blew it all the way to the moon. Enjoy.

Birth Story, the short and clean version:

Filbertine took only 6 hours to be born, and half of that was pain-free. In the second half, the labor escalated so dramatically that she may have been born in the car if it weren't for her posterior position. That position, my scar tissue and maybe just the way my body is caused a long pushing phase -- 1 and a half hours, or a full quarter of the whole labor. Our car wouldn't start when we tried to go to the hospital, and I was already ready to push, so the delay prolonged the most intense agony I have ever experienced. I didn't labor at all at the hospital and I bypassed triage for a delivery room; they were scrambling to take down my date of birth, etc., as I made the first real pushes. Filbertine's Apgars were 8 and 9, i.e., a healthy baby. As for all the measures I took to prepare myself for birth, here are the outcomes:

Midwife practice = somewhat effective, although I ended up with the most inflexible, most medical and least experience member of the group
Doula = helpful, although as I feared she did not focus on hypnosis during my labor
Hypnosis practice = helpful, possibly explanation for easy early labor and apparent pre-labor cervical dilation. however, I cannot honestly say that the mantra that the contractions would be "strong pressure sensations" and not pain was true. It hurt -- a LOT. Why else would I be screaming so much that my throat was raw the next day?
red raspberry leaf tea = apparently very effective (when I drank none of the tea, I had a 19-hour labor, with tea, 6-hour labor)
swimming and other exercises to prevent posterior baby/back labor = not effective

Birth Story, the Long Version Containing Highly Personal Info About My Va-jay-jay and Various Issues From Therein:

On Tuesday, Epu and Nutmeg came with me to my second non-stress test. I was almost 41 weeks pregnant. While sitting around in the examining room, we asked Nutmeg when she thought the baby would be born. She said Wednesday. Tomorrow, we asked, and she said, yes. Later I asked her what time she thought my contractions would start, and she said 11 a.m., and that we would have to go to the hospital “right away.” Since Nutmeg had also told us with the same kind of matter-of-fact confidence that our baby was going to be a girl, I kind of thought she might be right.

Wednesday morning Epu and I woke up before Nutmeg did, took a shower together, and had sex. It was the third time we'd tried this to bring on labor, and so far, nothing.

Just after 9 a.m. I got Nutmeg bundled up and we walked with the stroller to a public school just over a mile away where they have a toddler playtime. The other moms there were quite surprised to see me because I'd told them that last week was my due date. During the walk and the playtime I was feeling a lot of pelvic pressure, and I wondered if my bag of waters might break. I wasn't having many contractions – just an occasional light one when I stood up from sitting or otherwise changed positions. But I did feel several very strong twinges inside my vagina, which I hoped were signs that my cervix was opening. The baby would move, then I'd feel a strong cramplike feeling down there.

The day was cold and bright, without the wind that had made recent days so miserable. Nutmeg was cranky after the class, partly because we didn't get to play in the gym this time like we did last time, and I had to haul her out of the school after she had a tantrum in the bathroom. Just after we left the school I called my friend Sarah, who was also about to have a baby, and left her a message asking if she wanted to do lunch. Then we walked to Blockbuster Video and looked for a video for Nutmeg. She threatened to have another fit over renting “Lady and the Tramp,” which she already owns, but finally she decided she wanted a Ruby and Max video instead.

We walked home and had lunch, then we made carrot muffins with cream cheese frosting, and I got her down for her nap. I put in some laundry, did a few other things, and lay down to nap. I was woken up by my friend, who called to say she had actually had her baby and had just come home from the hospital. I talked to her a short while and then went back to bed and dozed, then woke up and read a little. I felt like resting more than usual. I finally got up just after 4, had half a cup of reheated coffee, and called another friend to chat while I did the dishes. I told her I wasn't feeling anything except pressure, but I still felt like this could be the day. I remember looking out the window at 5 and thinking how nice it was that it was still sunny and not dark out yet. The days were getting longer.

Nutmeg woke up just after 5, and wanted to put on her pajamas. I squatted down to open her bottom drawer so she could pick some. When I did this, I felt a trickle of something come out of my vagina. I thought, Hmm, is that something? But I'd felt this kind of thing before while pregnant so I didn't get too excited. After Nutmeg had her PJs on, I went to the bathroom and saw a large smear of mucous and bloody show. I felt excited, and even more so when it seemed like there was some fluid dripping out into the toilet. I put on a pad and as I stood up, I had a contraction and several more trickles of mucous and warm fluid came out. I wrote down the time: 5:17, and put on a PBS show that Nutmeg likes on the kitchen TV while I started dinner.

I had been worried that my water would break without labor beginning, because I feared ending up with a C section. To my relief, I continued having contractions. Within minutes of the initial trickle, I could feel that there was more wetness leaking into my underwear and pants. I put a towel on Erik's computer chair so I could grab a recipe off the Internet and made a quick post on my blog. I told Nutmeg that the baby may be coming tonight, and she was like, no kidding. I called my parents, who were scheduled to spend the night at our place anyway, to ask if they liked eggplant and to let them know that my water had probably broken. And I called Epu. He said he would leave work at his regular time, which would get him home by 7:10. My parents would be here sometime around then as well.

As I cooked eggplant Parmesan with a little help from Nutmeg, I jotted down contraction times. They were coming much more persistently than I had had them before in my pregnancy, except for maybe one other day two weeks earlier, also at the dinner preparation hour, when they had eventually petered out. This time, they were mild enough that I wasn't always sure when one was starting, and not very evenly spaced – my notes show something like this:

7 minutes
4 minutes
7 minutes
2 minutes (plus a trickle)
5 minutes
2 minutes
3 minutes
3 minutes
2 minutes (plus trickle)
2 minutes
5 minutes
8 minutes
3 minutes

Come to think of it, I probably missed recording a contraction where I have an 8-minute gap, because that's about when I called the midwife to let her know that I believed my water had broken. So those are mostly two-and three-minute gaps, not bad at all for labor just starting off. I called our doula as well. I seem to remember telling her, Epu and the midwife that the contractions ranged from five-to-eight minutes apart, which I can see now wasn't quite accurate. But since they were mostly only about 30 seconds long and not intense, no one was suspecting that there would be a big rush. The midwife told us to come to the hospital by 11 p.m., because I had tested positive for Group B Strep and was supposed to be there within 6 hours of a membrane rupture. The doula said she had just gotten a message from another client and hadn't yet had the chance to find out her situation. She said she would call me back shortly when she knew what was going on with the other person. I thought maybe I should do something later to stimulate the labor, like using a breast pump, but I was too busy at the moment.

I made some ice for my parents, and I read Nutmeg a story while sitting on my birth ball, then looked up another recipe – this one for coleslaw dressing – and mixed up some precut coleslaw. I set the table. Nutmeg asked if she could use her scissors at her table, which was a great activity for her at this point. When Epu got home at 7:11, I had just taken dinner out of the oven and was putting Nutmeg's plate together. I sat down with them and ate some buttered noodles. My mother had told me not to eat anything, because that's still the protocol at her hospital, but I told her the midwives recommended eating if you felt like it. I was also drinking water this whole time.

My contractions felt like they were getting longer and stronger, so I didn't feel I needed to do any home induction techniques. I had already changed my pad once or twice because the fluid was getting all over them and ruining the adhesive on the back. There was never a big gush of fluid, but at one point between 5 and 6 a few drops had dripped onto the kitchen floor, and now my pants were pretty damp, so I figured my water really had broken. I didn't feel too bad about having to go to the hospital by 11, since that seemed like a good time to go anyway rather than wait until the middle of the night when the temperature would be below 0. I tried lying down on the bed, with a towel under me, and listening to my “birth affirmations” tape, one of three tapes I have that are meant to be heard during labor. But I soon found that I felt uncomfortable while lying down through a contraction. The pressure seemed to be in my back, unfortunately. I tried sitting on my birth ball for awhile, and that was a little better. I had a bowel movement and thought, good to get that out of the way.

Our doula called around 7:30 and first Epu spoke to her, then I did, while pacing slowly around the bedroom. I told her I'd just had a 60-second long contraction, and that I felt like the level of intensity was going up quickly, but I still felt comfortable. She said her other client was also going to be delivering at our hospital, which is unusual because she doesn't do many births there. The other client's water had ruptured at 9 a.m., she was not in labor or in very early labor still, and was supposed to be there at 9 p.m. Tanya, the doula, said that she thought I would end up delivering first, and that she would either come to our house if we needed her first, or go to the hospital with her client at 9 and come meet me when I was checking in at 11. She offered to just come to our place right then – it's about an hour-long drive from her home – but I said we didn't need her yet. I thought it would be better if we could get Nutmeg off to bed before more people showed up. Tanya later told me she had been having a strong feeling that she really should be coming to my house right away, which was prescient given what happened next.

My parents arrived at around 8, and I came out and said hi to them, told them how I was doing and what was for dinner. I didn't think my dad would like the eggplant so I told him there was also ham with scalloped potatoes in the fridge. I sat on my birth ball and chatted with them for awhile. I was still comfortable, but I was starting to need to breathe deeply and make my body go limp during contractions. I went back to the bedroom to finish the affirmations tape, then as things intensified decided to take a shower. Tanya had advised against taking tub baths before 7 cm dilation, since you could relax your uterus too much and slow down the contractions. Since I was on the clock, I definitely didn't want to do that. I had another bowel movement – diarrhea this time – and took a nice shower, washed my hair and body. When I had a contraction, I tried going down on hands and knees with the spray on my back, which seemed to help a little. I dried off and put on the plaid nightshirt that I had wanted to wear while in labor. All this time my parents had been playing with Nutmeg and getting her ready for bed, and Epu had been cleaning up the kitchen. At 8:30 I asked him to call Tanya and ask her to come, and then come help me. I sat on my birth ball and he rubbed my back and talked me through a few contractions. I told him he had to talk faster. Then I had him put on the “hypnotic deepening” tape. When a contraction came I was beginning to moan and I kept trying different positions. Bending at the waist while leaning over the bed, with Epu applying counter pressure to my back, seemed to help. I also asked Epu to open up the Nux Vomica, an herbal remedy Tanya had suggested, because I was starting to feel nauseous. He struggled to get the package open, and once he did I sucked on two of them, but I soon threw up anyway.

This is where the story gets gross. While I was throwing up, I experienced some fecal incontinence in my underwear. I threw up my dinner into a trash can, then a little more into the toilet, then asked Epu to leave the bathroom so I could poop. I threw away my underwear and a washcloth I had placed in my underwear to soak up the fluid. I put on fresh underwear, scrubbed my hands, and then headed back to the bedroom for more moaning and listening to the tape.

Around 9:30, Tanya arrived, and Epu turned off the tape. I told her I was having trouble relaxing because the contractions were so painful. I said it was back labor. She felt my stomach and said it felt rounded, not flattened as it often is with back labor. Epu told her he'd been applying counter pressure to my back, and she said, you do that, and I'll run energy into that area. She was referring to quantum touch, a homeopathic technique that she does, which Epu and I don't really believe in and had told her we weren't interested in. We had hired her because she is also a hypnotherapist. But at the time I thought, what the hell, anything that might help me.

I yelled through a couple of contractions and pressed my back upwards toward Epu's hands. Tanya talked me through them, especially helping me notice just when the contraction was winding down and helping me calm down quickly from each one. Then I thew up again. And I asked Epu to take off my necklace, which was was getting in the way and which I didn't want to wear to the hospital. Every time one of them came in or out, I asked them to shut the door so Nutmeg wouldn't hear so much of my yells. Later my mother told me that Nutmeg was awake until after we left the house, and that she had looked concerned and asked about me. My mom just told her that this is what is supposed to happen when the baby's coming, and this reassured her.

After just a few contractions, as my yells escalated, Tanya asked me how much pressure I was feeling.

“A lot,” I said in a pitiful voice. It was true – here it was, only four hours into my labor, and I was feeling more pain than I had ever felt with my first labor, even after my water had broken the first time around. I don't think I ever yelled or screamed with Nutmeg's birth. With Nutmeg, I had gotten an epidural at 6 cm, after 9 to 12 hours of active labor, and about five hours after my water had broken. Tanya later told me she thought I as already complete when she arrived at our house, but at the time I didn't know this and thought maybe I was in for hours and hours of this kind of pain.

“I think we need to get to the hospital,” Tanya said calmly. “Let's get some clothes on her.”

My heart soared, at least until the next contraction hit. I had been about to ask if it was too soon to try the tub. I was also anxious to get out of the house so Nutmeg wouldn't keep hearing me yell. I told them I wanted to wear the nightshirt I had on and asked Epu to get me a pair of leggings. After briefly considering looking for a pair of socks that looked decent with my green-and-blue plaid nightshirt, I grabbed a pair of magenta socks and Tanya helped me pull them on. I walked out to the dining room and my mom hugged me and told me I was doing great and she was so proud. I felt kind of like a zombie. I asked that someone grab my purse out of the front hall, and my mother helped me put my coat on. I grabbed my hat and decided to wear some sandals that I keep by the back door instead of bending over to get into real shoes.

Epu went down our back stairs to the garage, carrying my birth ball and a few other things, and Tanya went out the front and said she'd meet us at the street that goes toward the hospital. My dad walked me down the snowy back stairs, saying, “Don't slip.” I told him I wouldn't. I remember holding the rails with my bare fingers. It was probably about 5 degrees out, but I have no memory of feeling cold. Partway down the stairs I had a contraction and I screamed much louder now that we were out of the house. It was the second contraction I'd had since he'd been walking me.

“That was less than a minute apart!” he said.

On the way down I asked my Dad to call the midwives to tell them we were on their way.

I got into the car and fastened my seat belt. I think I even reached over and pushed the button that opened the garage door. But then Epu turned the key and said, “It's not turning over.” Honest to God – our car would not start. My dad ran to get his SUV, which was parked on the street in front of our house. I told Erik to close the garage door so I could scream without the neighbors thinking there was a murder going on. Then my mom was there next to the open car door, seemingly out of nowhere.

“Mom, stay there,” I said, and got on my knees so she could press on my back. I didn't know until later that Mom had come down because she thought she might have to help deliver the baby. She works as a labor and delivery nurse, and she could tell how close I was. When we didn't leave right away, she figured the baby might be coming in the car.

My dad pulled up and I said I was getting in the back of their truck. But my mom reminded me that I couldn't because it was full of their samples from their postal uniform business. So I knelt on the front seat, leaning over the back of it, which was not a bad position. I closed my eyes and we were pulling into the hospital parking lot in just a few minutes since we only live a few blocks away. But it felt like a long time going around and around the parking ramp. Tanya met us when we got out of the truck. Epu was going to get the birth ball out of the back, but Tanya said don't. We walked together toward the bridge to the hospital building. It was locked. We couldn't believe how it seemed every possible hurdle had raised up in our path. Erik rang the buzzer for security and someone answered. It probably helped us get in quickly that I was screaming in the background.

While waiting for the elevator, Tanya told me, “I think you're ready to push as soon as we get in there.”

“God,” I said, “I hope you're right.” I was feeling like pushing, but I was so afraid that I was in this much agony at 6 cm and would be screaming like this all night long, or until I gave in and took an epidural. Which probably wouldn't take long, the way I was feeling.

We took the elevator to the third floor, and I went down to my knees across the open door just as it opened, so Epu had to hold the door open until my contraction was over. Someone asked if we needed a wheelchair, but I said, “I can't sit.” Then Epu picked up the phone outside the locked Birthing Center and calmly said that his wife was in labor.

The doors opened, I was screaming, and our midwife and a small group of nurses hustled us down the hall. The midwife asked me something like, “Do you feel like you're not going to make it?” I said yes.

Then I added, “Actually, can I use a toilet?”

“Do you need to go to the bathroom or do you feel like pushing?”

“Yes, I need to push. But first I need to go to the bathroom.”

“We need to see how the baby's doing first,” she said, and they took me straight to a delivery room. No triage for me.

Someone helped me take off my leggings and underwear and climb up on the bed. I saw that there was some poop on the pad I was wearing in my underwear, which was a little embarrassing, although I knew it also showed them that I was already pushing. The midwife on duty was my least favorite of all the midwives in the group, and it turns out my instincts about her were right: She was pretty medical in the delivery room and not very flexible. I lay down on my side, and she told me I had to lie on my back while they put the monitors on. Lying on my back was agony during the contractions. I closed my eyes and the midwife checked me.

“Can I push?” I asked. I did push, a little.

“Don't push,” the midwife said firmly.

“Why?” I wailed, and no one answered me.

“They're just setting everything up,” Tanya told me, which made me so happy. No one actually told me I was complete, so that was the only way I knew that this labor was really at the end.

Sure enough, moments later they were coaching me on pushing. I moved back onto my side. The first few pushes I was not settled down enough. I was still screaming at the contractions, arching my back, finding the place in myself where I was supposed to push. Unlike the pushing phase in my first labor, when I had an epidural, I really did feel the urge to push this time. Tanya told me later that she could tell that I was already starting to push back at home. But it's still not a physical activity that you do very often, so it took me some pushes to get into the sync of it.

After awhile I was doing the standard three pushes per contraction, and the pain actually stopped or almost stopped during the push. It was like, “Aiaah!” -- push -- “Aihh!” -- push -- “Aiahh!” push. Before very long the midwife asked me to return to my back. After some coaching I was curling my body properly and had mostly stopped screaming to put my energy into pushing instead. I would lock my hands behind my knees, and Epu and Tanya were each holding one of my legs up. I knew that I was going to have to finish voiding my bowels right there on the bed, since pushing out a baby and pushing out a bowel movement involve pretty much the same muscles. I felt the nurse wiping it away. Very weird, icky moment there, pooping in front of a roomful of people and having someone wipe you. Erik told me after our last birth that some poop happened then too, but with the epidural I couldn't feel it at the time.

I heard someone say at some point, “Baby's on the doorstep,” and I don't think that was very long into the pushing. Around then the pain began hanging around after the contractions ended, because the baby was low enough to put constant pressure on my pelvis. “Why am I on my back?” I moaned at some point.

“Do you want to try an upright position?” Tanya asked, and I said yes. But then another contraction hit and I focused on pushing, and I don't remember what happened but we never did try an upright position. Tanya told me later that she did ask the midwife if I could and the midwife told her that she just wanted to make sure the baby's heart rate stabilized first. I did get back onto my side, but then the midwife told me that the baby would come faster if I returned to my back, so I did. I think I also remember a nurse saying they were having trouble keeping the monitor on the fetal heart rate. I still don't understand why she would say the baby would come faster if I was on my back, but I think they mainly wanted me there so the monitor would work better. In their defense, the team had no chance to establish a baseline heart rate since I came in already pushing.

Tanya was murmuring encouragement to me during every contraction. I would have liked her to use the hypnotic techniques for managing discomfort that we learned in her class, but she didn't. She was holding my hand, which was nice, and she gave me some sips of water. At one point she asked for and got a cool cloth for my forehead. I was hot and sweaty. The midwife gave me a talk about making every push count, because she said some of my pushes weren't moving the baby forward. I tried harder. It was getting very hard to not push between contractions, because of the strong pressure, but the midwife told me that when I pushed in between, the baby didn't get a chance to rest.

One thing that Tanya did do well was to help me relax between contractions, despite the pain, and that really helped me gather my strength for the next one. And there were more “next ones” than I had hoped and expected. I'm not sure when I arrived and started pushing, but I think it was around 10 p.m. At maybe quarter to 11, the midwife gave me a talk about how I had to listen to her really closely when the moment of delivery came so she could help me ease the baby out and save my perineum, which had a fourth-degree tear the first time around. So I figured the moment was nearly at hand. Awhile later the midwife said that we really needed to delivery the baby on the next push, because her heart rate was dropping during pushes. If we didn't, she would have to cut an episiotomy. I looked at the clock at said that Nutmeg had been dead on with her prediction that 11 o'clock would be an important time in my labor (even though she had said 11 AM). There seemed to be agreement around the bed that the delivery would come at around 11. This gave me strength to push really hard the next few, and the midwife allowed me to keep pushing because the baby's heartbeat bounced back. (My doula later told me that she didn't think the baby's heart rate had ever dipped to worrisome levels.) At some point an obstetrician came in, although I didn't really notice who was coming in and out. When I opened my eyes I would see so many people looking down at me – the midwife, Tanya, Epu, and three or four nurses. I felt like a trapped animal. I also saw all the instruments laid out. I was semi-sitting, with the back of the bed up a bit.

The midwife was massaging my perineum, her fingers inside me trying to stretch out the skin. It hurt. Finally I felt the baby moving forward with a push, and I could feel her pressing on my perineum. I could feel the incredible pressure of her head in my vagina and I was pushing toward the pain of stretching, but I didn't hold back. Actually it wasn't as bad as the actual contraction pain so I kept cool. Someone asked if I wanted to feel the baby's head and I did. And then I pushed, pushed into the pain, but the baby still would not come out. Finally the midwife said she had to do the episiotomy, and in a push or two, she actually cut it. I don't remember feeling much of anything when she cut. I pushed again, hard, and the baby's head still didn't come out. She cut a little more. Finally, the head popped out on the next push, and I pushed more, and the body came out and it was the most intense feeling of relief I have ever experienced. Yes, like taking the biggest poop ever if you had to go really, really bad. But more so. In a flash the baby was on my chest, the cord still attached, and I checked and saw it really was a girl. The time of birth was 11:17, six hours to the minute from the start of labor. She came out facing up, proving that I was right when I told Tanya I was having back labor.

The moment you first lay eyes on your baby is supposed to be magical, obviously, but after both my births I regarded my child with more bemusement than anything, while I dealt with the primary feeling at hand – huge relief that the pain and the hard work of pushing was over. It was so intense, so seemingly inescapable, and just like that, it was gone. I was shaking violently, and Tanya put a warmed blanket over me even though I wasn't really cold. Someone clamped the cord and Epu cut it, and for the second time I didn't see this happen, although I do remember the nurse asking Epu if he wanted to. A nurse took the baby to a warmer just a couple feet away for some intensive suctioning – not just the bulb aspirator but the wall suction tube down the baby's throat. I asked her if she had given Filbertine an Apgar, and she said they were 8 and 9, which is great. Nutmeg's were only 6 and 8.

The midwife had the obstetrician examine my episiotomy and tear to see if it was muscle and sphincter or just skin that was damaged. The OB determined it was just skin. She gave the midwife some advice on stitching it. The midwife guided me on pushing out the placenta and showed it to me. They gave me a local anesthetic and started stitching. I could see my reflection in a television screen mounted on the wall – my legs spread, and lots of blood smeared in between.

Epu stood over Filbertine and talked to her in the warmer. Tanya held my hand. The stitching was nothing but a few little pricks, and the most painful part was when the midwife caught a pubic hair somehow and accidentally pulled it. A nurse gave me a shot of pitocin in my arm to help my uterus contract. I found it hilarious that the nurses apologized when giving me the shots, as if those tiny little pricks would upset me after what I had just gone through. I had a second-degree tear extending from the episiotomy.

They handed me Filbertine, swaddled in a blanket, and I tried to nurse her. My arms were so weak and shaky that I had to ask Epu to help me bring her to the breast. She may have sucked a little bit, not much. Tanya asked the nurses for a snack pack and some juice. I guzzled about four tiny cups of juice and ate half a sandwich. I couldn't believe how limp and wrung out I felt, and how my arms could barely lift anything.

The midwife laughed and said sorry we didn't have a chance to go over my birth plan or anything. I asked if she had gotten the call that we were on our way, and she said she hadn't. It turns out my dad had called the birth center phone number, while we were supposed to call the midwives' line. Still, I can't figure out why the midwife wouldn't have gotten the message.

Two days later, the midwife I would have liked to deliver me was on duty and she stopped by to see me. I told her that I couldn't understand why the other midwife had insisted that I stay on my back, and she said that this midwife was the youngest and least experienced in the practice and that it takes experience to become comfortable with different delivery positions. The midwife I like better is also the assistant director of the group, and she said she would discuss my feedback with the other midwife.

Thinking it over later I couldn't stop marveling at my whirlwind labor – only six hours, about half early labor and half active. But maybe an hour and a half of pushing, which is still kind of long when I hear so many repeat moms say they did “only a few pushes.” I spent 25 percent of my labor pushing!

When I compare it to my first labor – 19 hours, 3+ hours of pushing, episiotomy and fourth-degree tear – I find some constants that are probably just the way my body is. Although episiotomies are uncommon these days, especially in midwife care, I apparently need one to get a baby past my perineum. This time around the midwife told me the skin wouldn't stretch because of the scar tissue from the old tear, plus the fact that the baby was posterior and therefore her head was not in the optimum position for pushing through. The first time around, I worried that having an epidural caused my long pushing phase, but now I think it may have been almost as long even without an epidural, because I just do not have a very elastic perineum. When we talked it over later, the doula said she had seen my perineal skin holding the baby's bulging head back, something she has rarely seen before, and she agreed that I may well need another episiotomy if I ever have another child. She also said that I should definitely try to give birth standing, squatting or kneeling, something she'd been afraid to encourage due to my past tear, but now that she's seen how tough my skin is, she thought I should go ahead and do it to possibly shorten the pushing time.

I also wonder if there is something about my pelvis that makes posterior babies more likely. Nutmeg came out facing the right way, but from the description of my labor, Tanya thought Nutmeg might have been posterior and turned during her final descent through the birth canal. I had wondered the same thing. My mother told me that both my brother and I were posterior until the last minute. During both my pregnancies, in the final weeks, I did the recommended things for avoiding back labor – I avoided reclining and sat on a birth ball instead. I went swimming three times a week for the last couple of weeks. But the result was still a posterior baby. Again, I talked it over later with my doula and she said there is some research suggesting that some women are prone to repeat back labor. She personally has had multiple clients with more than one posterior baby. The theory, she said, is this: The bottom opening of the pelvis, called the pubic symphysis, is supposed to spread during late pregnancy to make more room for the baby to rotate into the proper position while exiting. But with some women, the hormone relaxin causes the symphysis to flatten out and lose its arch instead of spreading, which makes the opening smaller instead of bigger and prevents the baby from rotating. Not only does a posterior baby hurt the laboring mom by pressing its skull up against her spine, it also has trouble coming out because the head is not positioned optimally to open and move through the cervix and vagina.

One week into my recovery, I have realized that having a second-degree tear does not compare at all to a fourth-degree tear. Last time at this point I was still taking Vicodin every six hours. Today I stopped taking Motrin every six hours because I just don't need it anymore. I can see a big difference in Filbertine compared to Nutmeg – Filbertine is much, much less sleepy. The Vicodin probably had something to do with that.

All in all, I'm grateful for the short labor and amazed by the intensity of the last part of it. It amuses me that I spent so much time during my pregnancy planning and preparing for labor, and then in the rush of it I scarcely had the opportunity to use any of my preparation. After the birth, a friend asked me if the hypnosis “worked.” It's a hard question to answer. I'm guessing both all the pre-labor suggestions I'd been listening to and giving myself helped a lot when it came to remaining mellow and avoiding discomfort during the early part of the labor. But hypnosis did not offer me as much pain control as I would have liked during the short active phase. In all honesty, it was probably the worst pain I had ever experienced in my life. My throat was sore for the next two days from yelling so much. If I have another baby, I will probably use hypnosis again, and I will probably search for another doula. Although Tanya is wonderful and she did help, I feel like someone more focused on hypnotherapy could have done better at using those techniques to help cut down on the pain.


6 comments:

Felicia said...

Wow, I really enjoyed your birth story! Thanks for being so open about everything!

If you want, you can check out mine as well (posted on my blog). I'm still in the throes of updating the blog after the baby and I'm about 6 weeks behind, but the birth story itself is there.

Moxie Mom said...

Wow. Even I am reeling just having read your story.

You did such a tremendous job in the face of so many obstacles. Can I say I am proud of you without sounding hoocky?

I had such a violent and long labor my first time that almost anything would have been better my second time around. The cutting and tearing was a nightmare. I am glad to hear you are recovering nicely this time.

What an incredible story. Hugs!

tiffany said...

Wow. Beautiful story. Gore and all.

For some reason your birth stories are more comforting than any other I've read. Your honesty really makes it all the more informational.

So glad you're doing well.

Notta Wallflower said...

Your birth story is the first I've ever read. I admire that you can be so open about it. I hope all is going well. :-)

New Mama said...

Great birth story! It really makes me want to give birth again...which is probably not what most women who've never given birth would say. But your honestly and strength are very inspiring.

My first (and only) labor and delivery was 5 1/2 hours from start (water breaking) to finish -- very intense the whole time. I'm always amazed when women say they used the computer or tidied up the house or cooked something while in labor. For me that would have been IMPOSSIBLE.

Patagonia baby mum-to-be said...

Wonderful real story
It was very emotional and you told it so well.
Yamila