Thursday, June 23, 2016

Mira's Birth Story

Summary
Here is the summary for those of you who don’t want to read the whole story:

Mira was born just two days early on February 5, after about 24 hours of labor. I delivered with Park Slope Midwives at Methodist Hospital, only a half mile from our apartment. My hope was to labor at home as long as possible and delivery naturally without medication, which I managed even though she was poorly positioned. With the help of our doula (Jesse Pournaras), I found it manageable to cope with contractions and was already far along (9 cm) when we got to the hospital, which had us optimistic about an easy birth. However, her head was stuck behind my pelvic bone, so I was then in transition for more than three hours - this is when I wished I could get an epidural but was too far along. After three hours of directed pushing, she was still stuck. And the level of urgency increased because her heart rate went down, they had to put me on IV and oxygen, and she passed meconium in the womb. To help me push her out, one midwife pushed downward on my stomach and one pulled her outward to keep her from slipping backward between the last two contractions - I didn't know that was an alternative to interventions like vacuum and c-section until then! Amazingly, it worked, and Mira was born healthy.

Now for those of you who like details:

Preparations and Reflections
I had read a lot of birth stories over the years, so I was well aware that things don’t usually go according to plan. To learn about birth, I read Expecting Better (highly recommended!), The Birth Partner, and InaMay’s Guide to Childbirth, and we took a class with Birth Day Presence. I also listened to hypnobirthing scripts, and at first I thought the words were silly, but they were relaxing enough to help me fall asleep, and I focused on the message to be positive and optimistic about birth. I started out my pregnancy in great physical shape, lost momentum around the fourth month, but tried to keep up yoga, stretching and weights once a week through most of my pregnancy with the hope this would give me more stamina for birth (and yes, it was a workout for sure).

In my research, I learned that epidurals are not a magic bullet answer to pain because they come with their own risks. A video during class really hammered home how immobile and hooked up you are when you get an epidural. I decided that I wanted to labor as long as possible at home, where I’d be free to move around and eat and drink. I feared that an epidural would stall progress; would require directed pushing that might exacerbate my hip dysplasia; might make it hard to push and lead to other interventions; and might affect breastfeeding. Ironically, I had some of those problems anyway without having an epidural.

I feel like my birth story is almost two stories – it was relatively easy until it was extremely painful and difficult. If Mira had been better positioned, I think I would have come out of the experience feeling totally empowered about natural birth. (Interestingly, my mom said she also found labor pain manageable without medication.) But because of the extra long transition, I felt traumatized by how much pain I went through. Late in labor, I was thinking about how the human race could exist if this is what women have to go through to give birth. How evolution could be so cruel as to allow for so much pain and complications. I guess the mortality rate was a lot higher, and I guess the manual method they used to push our Mira is probably the same one that would have been used before modern technology. Who knows – maybe if I had an epidural it could have been too hard for me to push and led to a c-section. Or it could have gone the other way and given me a nice break and relaxed my body enough to allow her to move into a more favorable position. After about a week, my traumatized feelings started to fade as I realized most birth stories involve hardship and pain and my story was just another story.

I chose a midwife practice (Park Slope Midwives) that operates in a hospital (Methodist). There are several midwives in the practice, and I was greeted by my favorite one when I arrived at the hospital, who was then soon after replaced by a more brusque one, but I didn't really mind. The midwives were great about respecting my birth plan for a natural birth. The only hospital rule they wouldn't ignore was the ban on eating, which is unfortunate since recent research indicates this is no longer necessary. Based on how the birth went, I’m glad I went with my cautious desire to be in a hospital and have medical help immediately available. One downside of Methodist was its lack of a birthing tub. There are a couple in-hospital birthing centers with tubs and midwives in Manhattan, but I decided I’d rather use a hospital close to home, which would enable me to feel comfortable staying home longer. During labor, I didn’t even feel inclined to try the shower, so it didn’t turn out to be an issue. Although, I wonder if a birthing tub would have relieved some of the terrible transition pain. 

My number one recommendation about birth is to have a doula. I knew I wanted one because they are statistically proven to reduce the likelihood of a c-section and because it would enable us to feel comfortable staying home longer. I expected the midwife to be around more in the hospital, but she actually wasn’t – much like a doctor. Our nurse, who was very sweet but very young and seemingly inexperienced, also wasn’t always in the room. (Kind of wonder if they would have been around more if we didn't have a doula?) In contrast, our doula Jesse Pournaras was there for us the whole time, from when we first called her over to our apartment on Thursday all the way to the late hours after birth. Plus, as my prenatal yoga teacher, she taught an awesome private session beforehand with yoga and meditation for birth. She guided us through the whole process, gave us feedback on our birth plan, suggested different positions, helped us decide when to go to the hospital, was very active in the hospital with getting me things I needed, constantly massaged me, kept me hydrated, and stayed longer than I expected after the birth not just to help with breastfeeding but make sure I was okay before she left. I don’t know how I could have done it without her. Especially at the hospital when I despaired of what to do -- I can’t imagine having to go through that alone with just Evan. And it makes me sad that lots of women do it alone -– and no wonder then that they sometimes turn to epidurals out of fear.

Going into Early Labor
I went into labor on Wednesday, February 3, about half a week before my due date of Sunday, February 7. I had hoped for a week off from work to finish up some baby to dos and relax, but due to my workaholic nature, I couldn’t stop myself from working and worked from home a couple extra days. Then since she was born a few days early, I never did get around to the massage and relaxation I was hoping for.  On Monday and Tuesday I did a lot of walking around for last minute shopping and then felt pretty achy on Wednesday.

I went to acupuncture that Wednesday morning, which may have been what kick started labor. In my last few weeks of pregnancy, Mira seemed to be in a somewhat posterior position on the right side. I never felt any kicks in my ribs – her head down with more pressure on my right hip, her bum around my belly button and her legs kicking off to my left. Despite doing inversions and positions suggested by Spinning Babies and my doula, Mira seemed very content there. I had already been going to acupuncture for stress relief since week 36, so that Wednesday morning, I had an acupuncture session to focus on getting her to move into a better position. Apparently, she did move sometime between then and delivery, but unfortunately not into a better position.

A couple hours later, I started having what felt like the Braxton Hicks contractions I’d been having throughout pregnancy, but with some cramping radiating from my bottom up my lower back. It felt so mild it took me a bit to acknowledge they could be real contractions. Once I did, I got myself to finally stop working. These contractions continued on and off most of the day. Evan and I both felt unsettled, not knowing whether I was going into real labor or not. So I went ahead and made a spicy chicken tortilla soup like I had been planning for dinner, pushing myself through tiredness to make it.

Regular Contractions
At 1:30am, I was awoken by somewhat stronger contractions that were coming every 10 minutes and about 45 seconds long. I couldn’t sleep through them, but I was able to sleep in between them. I mostly focused on my breathing to get through them. I went out to sleep on the couch so I could do deep breathing or shift positions without waking Evan up. Apparently unbeknownst to me, he realized halfway through the night what was going on and then spent an hour reading baby names in bed instead of sleeping.

Evan got up around 7am and I texted my doula to let her know what was going on. Evan got to enjoy his usual very nice breakfast, and made some scrambled eggs for me. At 10am, we walked a half mile to my midwives’ office. I was worried that my water may have been leaking a bit on Tuesday night and Wednesday, and I wanted to get that checked. It was great to be able to take advantage of my midwife practice being in my neighborhood, so I could easily go to their office to be checked rather than go straight to the hospital. The midwife was unconcerned about my water. Mostly, I was pleasantly surprised when she told me I was already 5 or 6cm dilated. The contractions were around 6 or 7 minutes apart at this point and still feeling painful for about 45 seconds.

The midwife agreed it would be fine for us to go back home and labor longer with our doula before going to the hospital. Which I thought was interesting because most people go to the hospital when they are 5-6 cm dilated, but I didn’t feel the need to go to the hospital yet. It was a pleasantly warm day for February, and I was feeling more relaxed and positive on the walk home. We had to stop often for contractions, but I still found them manageable as I leaned on Evan or fences along the way for support.

Laboring at Home
We weren’t sure if we needed our doula yet, but since she needed an hour of travel time, we called on her to come over. We watched some TV while we waited. Once she arrived, we turned on the soothing quiet indie music playlist that I made for labor. At this point, I was still able to chat, and I had some toast and peanut butter --  a benefit of staying home a long time was being able to eat and drink to stay fueled.

It’s hard to remember exactly what I was doing as all the hours passed during labor. I think I mainly focused on using my breath to get through contractions, and tried to relax my body into it, rather than tensing against it. The doula was able to suggest different positions and comfort measures, like leaning over an exercise ball. My favorite was a hot water bottle against my lower back. She also guided me through a series of positions specifically to try to help move the baby – rebozo shifting, playful puppy, side lying, and the standing lift and tuck. After she had been there for some time, I worried that the contractions weren’t getting any closer together and worrying that progress had stalled.

Around 4pm, Evan and I retreated to the bedroom for some alone time. This is when the pain level picked up, and I began to understand why people get epidurals. Evan led me through a progressive relaxation meditation like we had practiced, but I found it uncomfortable to lay still.

Around 5 or 5:30pm, the doula suggested we could think about going to the hospital soon if I wanted, though she also thought we could stay home longer. Soon afterward, I decided we should go, since the contractions were every 2-3 minutes. They had gotten painful enough that I couldn’t imagine having to deal with getting through the journey, short as it may be, while having contractions even closer together.

We had considered walking to the hospital, but now I realized that would take forever, and I didn’t want to keep stopping on the street in pain. This was a good decision, because despite being only a couple minutes from the hospital by taxi, it still took an hour between when we left our apartment at 6pm, went through triage and registration, and was settled into our delivery room by 7pm.

Off to the Hospital and Transition
In triage, we were greeted by my favorite midwife in the practice, who checked me and announced I was 9cm dilated and 100% effaced. Plus, my water broke while she was checking me. This had us very optimistic that I would have the baby soon. As planned, I was able to avoid getting a hep lock (a catheter usually administered during triage to easily put in an IV later). Because they wanted to get me into a delivery room quickly, I also didn’t have to do twenty minutes of continuous monitoring on the bed in triage and was able to do it standing in my delivery room instead. I had a couple contractions while in triage but dealt with them so calmly that the nurse remarked that I “must meditate.” (I don’t, though I do yoga!)

Once we got to our room, things picked up again. We also got a different midwife, one who is much more brusque. The contractions increasingly felt like they were on top of each other, and the pain took time to subside after each contraction, which made the breaks in between even shorter. The pain was, as I told my friends the next morning, holy shit terrible. I kept thinking if I had known it was going to hurt this much, I would have gotten an epidural. I thought desperately how nice it would be to have a break before having to push, like you get with an epidural. I had thoughts like “just cut her out of me,”, “just make it end”, etc, though I didn’t ever say them out loud. But when I asked my doula if it was too late for an epidural, she said it was. (I took her word for it and didn't actually ask the nurse or midwife, but it's possible they might have responded differently?)

I labored on the toilet for a while, which I found to be one of the more comfortable positions. The only other position I remember tolerating was standing leaning over the bed while Evan and the doula’s hands continued to massage my back. There was a birthing ball in the room, but I don’t remember using it much. After it had been a while, a midwife came in and checked me and said I was 10 cm dilated, but then left again.

Time passed in a blur. Every now and then I looked up at the clock occasionally and was depressed that so much time had gone by. I expected transition to be terrible, but had planned to get through it with the knowledge that it usually only lasts for a half hour to an hour. I was in transition for more than three hours, depending on how you count it (it didn’t feel like transition-level pain until I got to my hospital room, but they say transition usually starts around 8cm and I was already 9cm when I got to the hospital). As the hours went by and I seemed stuck without getting an urge to push, I despaired of not knowing what to do. I wanted someone to give me direction and tell me how to progress out of this pain. My doula suggested I try bearing down, but that didn’t get me anywhere.

Pushing
Finally, around 10pm, the midwife came back and started directed me in pushing. I thought I had been bearing down and pushing before, but once the midwife was involved, I realized that pushing would be much harder work than expected and more like an athletic event. I had bought into the idea that I would have a natural urge to push and would be able to breathe the baby out. Instead, the midwife stuck her hand inside me to give me something to push against, while she and the nurse yelled at me each time to push harder and longer. I know they were trying to encourage good pushing, but it actually made me feel like I wasn’t doing a good job, because I was already pushing as hard and long as I could.

After each push, I’d flop back down on the bed, heave in air, take a sip of water, juice or coconut water offered by Evan and the doula, and think I couldn’t keep going. But somehow I did keep going, one exhausting push at a time, for three hours. I felt a delayed, spacey, out-of-body experience in between pushes, probably due to my exhaustion and lack of oxygen (and this feeling actually continued until a day or two after birth!).

I remember pushing on the bed in an elevated all fours position and also tried pushing while lying on my side with a peanut ball. But I mostly pushed in the traditional position, even though this was something I that I had actually wanted to avoid for two reasons. One, I was worried it would aggravate my hip dysplasia (for all the years I worried that pregnancy and birth would make my hip dysplasia worse, luckily that did not happen!). And I was worried it would stall progress, but in the moment I was willing to do whatever the midwife recommended. My doula used a sheet for us to tug on to also give me something to push against (which left my arms incredibly sore along with the rest of my body the next few days).

It seemed impossible that I could actually push hard enough for the baby trapped inside to actually pass out of me. At one point, someone asked if I wanted to feel her head or see her in a mirror, but I said not now, maybe later. Perhaps I should have – perhaps it wouldn’t have seemed so impossible then. I kept asking how it was going, and Evan was the only one to give me encouragement. He could see that the baby was coming out further each time, but then slipping back. No one else wanted to tell me the discouraging truth that I wasn’t progressing because she was stuck. We tried a technique suggested by my doula, which involved not pushing for a few contractions while my butt and legs hung off the end of the bed, but that didn’t improve things.

After a couple hours, the baby’s heart rate started to go down, so they put me on an IV and an oxygen mask to keep me going. I couldn’t feel a difference in my energy, but the baby’s heart rate went back up, and I did keep pushing. Another hour after that, the baby passed meconium, so the level of urgency increased. (Meconium is a baby’s first poop and if passed while still in the womb, there is risk of baby inhaling it during birth.).I should have been worried for Mira, but honestly, I was so focused on wanting the pain and pushing to be over that I didn’t have the energy or wherewithal to worry about it.

They had me sign a form. I did not understand what it was for at the time, but Evan later told me I was signing over to them the right to decide what care was best for me, since they worried that I might lose my ability to make decisions. Evan also later told me that the midwife kept leaving the room to prep the hospital for other interventions that might be needed, perhaps even a c-section. He also heard someone say that it would have been a difficult c-section due to her position.

Since my birth plan stated that I wanted to avoid interventions such as vacuum, forceps, or c-section, they brought in a doctor to try a more manual intervention first. The midwife stressed that this would be my last shot, and after that they would have to proceed to further intervention.

The midwife got up on the bed to straddle me and, during my next push, she pushed downward on my stomach, while the doctor pulled the baby outward. Mira’s head came halfway out, and they used the force of their hands to hold her in place and keep her from slipping backwards in between contractions. Then, in the next contraction, I had to push out the rest of her head and body all at once. (Whereas ordinarily the whole head comes out in one push, and the body in the next.) I screamed, but this pain was so brief that it barely mattered compared to everything that came before it. Suddenly, she was out. After so many hours of pushing unsuccessfully, it seemed impossibly lucky to me that this actually worked. (Evan told me the last was by far my longest and best push yet, though it all felt the same to me.)

It turns out that she was right occipital slightlytransverse and asynclitic, which means her chin was lifted instead of tucked. She was stuck, which was why I never got the overwhelming urge to push.

After the Birth
My birth plan included immediate skin-to-skin, which the hospital encourages. However, I did not feel ready to hold her. Instead of the euphoria and desire to hold my baby that I expected, I felt strangely distanced and fine to let the staff whisk her away to the incubated bassinet in the room to check on her. I was more focused on recovering from the trauma I’d just been through.

Luckily she hadn’t taken in any meconium and she started crying right away. She was born at 12:51am, about 24 hours after regular contractions started the night before (and about 36 hours after I first started feeling real contractions). She measured 7 pounds 10 ounces and 18.75 inches long. Despite the difficult birth, she got a 10/10 on her Apgar score. (Starting early with the perfect scores!) We didn't decide on her name Mira Lark until two days later.

They gave her to Evan, who held her skin-to-skin and sang one of the lullabies we had learned for her, with tears in his eyes. He held her for about a half hour, while I watched them detachedly them from the bed. I lay shaking uncontrollably while they proceeded with the after-birth procedures like delivering the placenta and stitches. Although pushing for a long time would have protected me against tearing, the manhandling last push resulted in three tears. I just could not stop shaking. While the midwife stitched me up, I told her I was concerned that my shaking would affect the stitches, and she didn’t even bother to respond. They gave me pitocin through an IV, which I hadn’t really wanted and didn’t realize I would need to be hooked up through the next day, but it seemed prudent to avoid hemorrhage because of the difficult birth.

Finally, Evan brought Mira over and laid her on me. I was so tired that I can barely remember the experience. Just that we tried to breastfeed and our doula tried to help, but Mira kept arching away. At the time, I wasn’t worried about this, but it was a sign of problems with breastfeeding to come. (Apparently, difficult births and asynclitic positions are associated with difficulty latching.)

Afterward, I was so tired and just wanted to go to sleep, but we had to wait what felt like too long to move to our recovery room.  I suppose because they had to prepare the room, and they had to wait for me to be recovered enough to be able to get out of the bed and go to the bathroom on my own and get into a wheelchair. Once we got to our room, a terrible nurse kept us up even longer with a lecture about how to care for an infant, including the advice that we should leave the light on to make sure the baby didn’t choke in her sleep! Just what new parents want to hear at 4am!

The next morning, I have fond memories of Mira sleeping in the crook of my arm while the early morning sun shone through a big window in our private recovery room. Evan nicely handled picking her up to bring her to me or soothe her when she cried, and even wore her in the wrap, because I could barely move. After 42 hours of several different nurses and doctors poking their heads in at random intervals, we left early, staying only one more night instead of two. We walked her home in the stroller on a calm February evening. Once we got home, another chapter began, focused on teaching Mira how to eat, but that is a story for another day.


1 comment:

  1. Thank you so much for sharing this! What a journey. I am amazed by your strength.

    ReplyDelete